hospital_name last_updated_on version location_name hospital_address license_number|GA type_2_npi "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula." attester_name general_contract_provisions Warm Springs Medical Center 3/30/2026 3.0.0 Warm Springs Medical Center "5995 Spring St, Warm Springs, GA 31830" 099-662 1972731800 TRUE Shannon Dukes description code|1 code|1|type code|2 code|2|type code|3 code|3|type modifiers billing_class setting drug_unit_of_measurement drug_type_of_measurement standard_charge|gross standard_charge|discounted_cash standard_charge|Aetna|Commercial|negotiated_dollar standard_charge|Aetna|Commercial|negotiated_percentage standard_charge|Aetna|Commercial|negotiated_algorithm median_amount|Aetna|Commercial 10th_percentile|Aetna|Commercial 90th_percentile|Aetna|Commercial count|Aetna|Commercial standard_charge|Aetna|Commercial|methodology additional_payer_notes|Aetna|Commercial standard_charge|Aetna|Medicare|negotiated_dollar standard_charge|Aetna|Medicare|negotiated_percentage standard_charge|Aetna|Medicare|negotiated_algorithm median_amount|Aetna|Medicare 10th_percentile|Aetna|Medicare 90th_percentile|Aetna|Medicare count|Aetna|Medicare standard_charge|Aetna|Medicare|methodology additional_payer_notes|Aetna|Medicare standard_charge|Amerigroup|Medicaid|negotiated_dollar standard_charge|Amerigroup|Medicaid|negotiated_percentage standard_charge|Amerigroup|Medicaid|negotiated_algorithm median_amount|Amerigroup|Medicaid 10th_percentile|Amerigroup|Medicaid 90th_percentile|Amerigroup|Medicaid count|Amerigroup|Medicaid standard_charge|Amerigroup|Medicaid|methodology additional_payer_notes|Amerigroup|Medicaid standard_charge|BCBS|Commercial|negotiated_dollar standard_charge|BCBS|Commercial|negotiated_percentage standard_charge|BCBS|Commercial|negotiated_algorithm median_amount|BCBS|Commercial 10th_percentile|BCBS|Commercial 90th_percentile|BCBS|Commercial count|BCBS|Commercial standard_charge|BCBS|Commercial|methodology additional_payer_notes|BCBS|Commercial standard_charge|BCBS|Medicare|negotiated_dollar standard_charge|BCBS|Medicare|negotiated_percentage standard_charge|BCBS|Medicare|negotiated_algorithm median_amount|BCBS|Medicare 10th_percentile|BCBS|Medicare 90th_percentile|BCBS|Medicare count|BCBS|Medicare standard_charge|BCBS|Medicare|methodology additional_payer_notes|BCBS|Medicare standard_charge|Caresource|Medicaid|negotiated_dollar standard_charge|Caresource|Medicaid|negotiated_percentage standard_charge|Caresource|Medicaid|negotiated_algorithm median_amount|Caresource|Medicaid 10th_percentile|Caresource|Medicaid 90th_percentile|Caresource|Medicaid count|Caresource|Medicaid standard_charge|Caresource|Medicaid|methodology additional_payer_notes|Caresource|Medicaid standard_charge|Cigna|Commercial|negotiated_dollar standard_charge|Cigna|Commercial|negotiated_percentage standard_charge|Cigna|Commercial|negotiated_algorithm median_amount|Cigna|Commercial 10th_percentile|Cigna|Commercial 90th_percentile|Cigna|Commercial count|Cigna|Commercial standard_charge|Cigna|Commercial|methodology additional_payer_notes|Cigna|Commercial standard_charge|Humana|Commercial PPO|negotiated_dollar standard_charge|Humana|Commercial PPO|negotiated_percentage standard_charge|Humana|Commercial PPO|negotiated_algorithm median_amount|Humana|Commercial PPO 10th_percentile|Humana|Commercial PPO 90th_percentile|Humana|Commercial PPO count|Humana|Commercial PPO standard_charge|Humana|Commercial PPO|methodology additional_payer_notes|Humana|Commercial PPO standard_charge|Humana|Medicare|negotiated_dollar standard_charge|Humana|Medicare|negotiated_percentage standard_charge|Humana|Medicare|negotiated_algorithm median_amount|Humana|Medicare 10th_percentile|Humana|Medicare 90th_percentile|Humana|Medicare count|Humana|Medicare standard_charge|Humana|Medicare|methodology additional_payer_notes|Humana|Medicare standard_charge|Peachstate|Medicaid|negotiated_dollar standard_charge|Peachstate|Medicaid|negotiated_percentage standard_charge|Peachstate|Medicaid|negotiated_algorithm median_amount|Peachstate|Medicaid 10th_percentile|Peachstate|Medicaid 90th_percentile|Peachstate|Medicaid count|Peachstate|Medicaid standard_charge|Peachstate|Medicaid|methodology additional_payer_notes|Peachstate|Medicaid standard_charge|Tricare|Commercial|negotiated_dollar standard_charge|Tricare|Commercial|negotiated_percentage standard_charge|Tricare|Commercial|negotiated_algorithm median_amount|Tricare|Commercial 10th_percentile|Tricare|Commercial 90th_percentile|Tricare|Commercial count|Tricare|Commercial standard_charge|Tricare|Commercial|methodology additional_payer_notes|Tricare|Commercial standard_charge|UHC|Commercial|negotiated_dollar standard_charge|UHC|Commercial|negotiated_percentage standard_charge|UHC|Commercial|negotiated_algorithm median_amount|UHC|Commercial 10th_percentile|UHC|Commercial 90th_percentile|UHC|Commercial count|UHC|Commercial standard_charge|UHC|Commercial|methodology additional_payer_notes|UHC|Commercial standard_charge|UHC|Medicare|negotiated_dollar standard_charge|UHC|Medicare|negotiated_percentage standard_charge|UHC|Medicare|negotiated_algorithm median_amount|UHC|Medicare 10th_percentile|UHC|Medicare 90th_percentile|UHC|Medicare count|UHC|Medicare standard_charge|UHC|Medicare|methodology additional_payer_notes|UHC|Medicare standard_charge|Wellcare|Medicare|negotiated_dollar standard_charge|Wellcare|Medicare|negotiated_percentage standard_charge|Wellcare|Medicare|negotiated_algorithm median_amount|Wellcare|Medicare 10th_percentile|Wellcare|Medicare 90th_percentile|Wellcare|Medicare count|Wellcare|Medicare standard_charge|Wellcare|Medicare|methodology additional_payer_notes|Wellcare|Medicare standard_charge|min standard_charge|max additional_generic_notes FINE NEEDLE ASPIRATION 10021 CPT 96100212 CDM 520 RC Facility Outpatient 423 211.5 308.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 321.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166 372 FNA W/IMAGING GUIDANCE 10022 CPT 97100222 CDM 520 RC Facility Outpatient 198 99 144.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 174 I&D COMPLEX POSTOP WOUND INFECTION 10180 CPT 99101802 CDM 520 RC Facility Outpatient 522 261 381.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 459.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 396.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205 459 "DEBRIDEMENT,SKIN FULL THICKNESS" 11041 CPT 97110413 CDM 963 RC Facility Outpatient 115 57.5 83.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 101 "DEBRIDEMENT,SKIN & SUB TISSUE" 11042 CPT 97110423 CDM 963 RC Facility Outpatient 153 76.5 111.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 134 "DEBRIDEMENT,SKIN,SUB TISSUE & MUSCLE" 11043 CPT 97110433 CDM 963 RC Facility Outpatient 728 364 531.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 640.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 582.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 292.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 582.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 553.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286 640 DEBMNT MUSCLE/FASCIA EA ADD 20 SQ CM 11046 CPT 97110461 CDM 960 RC Facility Outpatient 115 57.5 83.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 101 SKIN BIOPSY SINGLE 11100 CPT 97001034 CDM 520 RC Facility Outpatient 162 81 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 BIOPSY SKIN SUBCUTANEOUS ADDTL LESION 11101 CPT 97001032 CDM 963 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 REMOVAL OF SKIN TAGS (UP TO 15) 11200 CPT 97112002 CDM 520 RC Facility Outpatient 243 121.5 177.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 213 EXC BENIGN LESION INC MARGINS 4.0 CM 11426 CPT 97114262 CDM 520 RC Facility Outpatient 802 401 585.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 315.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 331.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 705.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 641.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 322.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 641.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 609.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 315 705 EXCISION BENIGN LESION 0.5CM OR LESS 11440 CPT 98001012 CDM 520 RC Facility Outpatient 765 382.5 558.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 351.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 405.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 351.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 673.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 351.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 581.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 351.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 351.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301 673 EXC MALIG LESION DIAMETER 2.1 TO 3.0 CM 11603 CPT 97116031 CDM 960 RC Facility Outpatient 577 288.5 421.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 305.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 507.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227 507 EXC MALIG LESION DIAMETER 2.1 TO 3.0 CM 11603 CPT 97116032 CDM 520 RC Facility Outpatient 577 288.5 421.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 305.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 507.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227 507 EXC MALIG LESION DIAMETER 2.1 TO 3.0 CM 11603 CPT 97116033 CDM 963 RC Facility Outpatient 577 288.5 421.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 305.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 507.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227 507 EXC MAG LESION FACE 3.1 4.0CM 11644 CPT 97116443 CDM 963 RC Facility Outpatient 815 407.5 594.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 321.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 337.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 327.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 619.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 321 717 "EXCISION,MALIG LESION FACE/EAR/EYELID/NO" 11646 CPT 97005322 CDM 963 RC Facility Outpatient 1193 596.5 870.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 470.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 632.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 493.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 954.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 479.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 954.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 906.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 470 1049 NAIL PLATE AVULSION SIMPLE 11730 CPT 96117301 CDM 960 RC Facility Outpatient 300 150 219 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 264 NAIL PLATE AVULSION SIMPLE 11730 CPT 96117302 CDM 520 RC Facility Outpatient 300 150 219 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 264 EXC.PILONIDAL CYST 11770 CPT 9700010 CDM 520 RC Facility Outpatient 554 277 404.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 293.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 421.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218 487 WOUND REPAIR/SIMPLE 12001 CPT 97120012 CDM 520 RC Facility Outpatient 165 82.5 120.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 839.17 90.4 839.59 1 through 10 Percent of Total Billed Charges 53 90.4 90.4 90.4 1 through 10 Percent of Total Billed Charges 90.18 90.18 90.18 1 through 10 Percent of Total Billed Charges 145.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 132 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 100.28 95.92 115.54 1 through 10 Percent of Total Billed Charges 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 145 SIMPLE LAC REPAIR SCALP/TRUNK 2.6-7.5CM 12002 CPT 3000151 CDM 450 RC Facility Outpatient 218 109 159.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1126.68 976 1126.7 1 through 10 Percent of Total Billed Charges 53 90.4 90.4 90.4 1 through 10 Percent of Total Billed Charges 90.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 SIMPLE LAC REPAIR SCALP/TRUNK 2.6-7.5CM 12002 CPT 97120021 CDM 960 RC Facility Outpatient 212 106 154.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1126.68 976 1126.7 1 through 10 Percent of Total Billed Charges 53 90.4 90.4 90.4 1 through 10 Percent of Total Billed Charges 87.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 186 SIMPLE LAC REPAIR SCALP/TRUNK 2.6-7.5CM 12002 CPT 97120022 CDM 520 RC Facility Outpatient 212 106 154.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1126.68 976 1126.7 1 through 10 Percent of Total Billed Charges 53 90.4 90.4 90.4 1 through 10 Percent of Total Billed Charges 87.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 186 SIMPLE LAC REPAIR SCALP/TRUNK 2.6-7.5CM 12002 CPT 97120023 CDM 963 RC Facility Outpatient 212 106 154.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1126.68 976 1126.7 1 through 10 Percent of Total Billed Charges 53 90.4 90.4 90.4 1 through 10 Percent of Total Billed Charges 87.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 169.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 186 SIMPLE RPR SUPERFICIAL WND OVER 30.0 CM 12007 CPT 97120071 CDM 960 RC Facility Outpatient 498 249 363.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 263.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 378.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 438 SIMPLE RPR SUPERFICIAL WND OVER 30.0 CM 12007 CPT 97120072 CDM 520 RC Facility Outpatient 498 249 363.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 263.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 378.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 438 SIMPLE LAC REPAIR FACE 0.0-2.5CM 12011 CPT 3000152 CDM 450 RC Facility Outpatient 218 109 159.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 852.04 852.04 852.04 1 through 10 Percent of Total Billed Charges 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 218 218 218 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 WOUND REPAIR 2.5 OR LESS 12011 CPT 97120113 CDM 963 RC Facility Outpatient 349 174.5 254.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 852.04 852.04 852.04 1 through 10 Percent of Total Billed Charges 160.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 218 218 218 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 279.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137 307 SIMPLE LAC REPAIR FACE 2.6-5.0CM 12013 CPT 3000153 CDM 450 RC Facility Outpatient 239 119.5 174.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 126.67 126.67 126.67 1 through 10 Percent of Total Billed Charges 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 210 REPAIR INTERMEDIATE WOUNDS 12037 CPT 97120371 CDM 960 RC Facility Outpatient 968 484 706.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 513.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 851.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 774.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 389.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 774.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 735.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 851 REPAIR COMPLEX TRUNK 2.6cm to 7.5cm 13101 CPT 97131011 CDM 960 RC Facility Outpatient 853 426.5 622.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 342.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336 750 REPAIR COMPLEX TRUNK 2.6cm to 7.5cm 13101 CPT 97131012 CDM 520 RC Facility Outpatient 853 426.5 622.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 342.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336 750 REPAIR COMPLEX TRUNK 2.6cm to 7.5cm 13101 CPT 97131013 CDM 963 RC Facility Outpatient 853 426.5 622.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 342.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 682.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336 750 REPAIR COMPLEX TRUNK EA ADD 5CM OR LESS 13102 CPT 97131021 CDM 960 RC Facility Outpatient 227 113.5 165.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 199 REPAIR COMPLEX TRUNK EA ADD 5CM OR LESS 13102 CPT 97131022 CDM 520 RC Facility Outpatient 227 113.5 165.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 199 REPAIR COMPLEX TRUNK EA ADD 5CM OR LESS 13102 CPT 97131023 CDM 963 RC Facility Outpatient 227 113.5 165.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 199 "REPAIR COMPLEX,SCALP/ARMS/LEGS;2.6/7.5CM" 13121 CPT 97131211 CDM 960 RC Facility Outpatient 978 489 713.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 518.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 860.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 743.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385 860 "REPAIR COMPLEX,SCALP/ARMS/LEGS;2.6/7.5CM" 13121 CPT 97131212 CDM 520 RC Facility Outpatient 978 489 713.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 518.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 860.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 743.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385 860 "REPAIR COMPLEX,SCALP/ARMS/LEGS;2.6/7.5CM" 13121 CPT 97131213 CDM 963 RC Facility Outpatient 978 489 713.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 518.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 860.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 743.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 449.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385 860 CX RPR FOREHD CHK CHIN MTH 2.6cm to 7.5c 13132 CPT 97131321 CDM 960 RC Facility Outpatient 1409 704.5 1028.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 746.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 582.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1239.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 566.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1070.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555 1239 CX RPR FOREHD CHK CHIN MTH 2.6cm to 7.5c 13132 CPT 97131322 CDM 520 RC Facility Outpatient 1409 704.5 1028.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 746.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 582.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1239.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 566.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1070.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555 1239 CX RPR FOREHD CHK CHIN MTH 2.6cm to 7.5c 13132 CPT 97131323 CDM 963 RC Facility Outpatient 1409 704.5 1028.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 746.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 582.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1239.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 566.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1070.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 648.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555 1239 CX RPR FOREHD CHK CHIN MTH 5cm or less 13133 CPT 97131331 CDM 960 RC Facility Outpatient 401 200.5 292.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 304.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157 352 CX RPR FOREHD CHK CHIN MTH 5cm or less 13133 CPT 97131332 CDM 520 RC Facility Outpatient 401 200.5 292.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 304.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157 352 CX RPR FOREHD CHK CHIN MTH 5cm or less 13133 CPT 97131333 CDM 963 RC Facility Outpatient 401 200.5 292.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 304.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157 352 Exc open wound/incis rel 1st 100 sq cm 15004 CPT 97150041 CDM 960 RC Facility Outpatient 820 410 598.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 434.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 339.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 721.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 329.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 623.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323 721 Exc open wound/incis rel 1st 100 sq cm 15004 CPT 97150042 CDM 520 RC Facility Outpatient 820 410 598.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 434.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 339.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 721.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 329.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 623.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323 721 Exc open wound/incis rel 1st 100 sq cm 15004 CPT 97150043 CDM 963 RC Facility Outpatient 820 410 598.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 434.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 339.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 721.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 329.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 623.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323 721 DRESSINGS/DEBRIDMENT PARTIAL THICK BURNS 16020 CPT 97001035 CDM 520 RC Facility Outpatient 163 81.5 118.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 143 DRESSINGS/DEBRIDMENT PARTIAL THICKNESS 16020 CPT 98001015 CDM 520 RC Facility Outpatient 163 81.5 118.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 143 DESTRUCTION BENIGN LESIONS 17110 CPT 97171101 CDM 960 RC Facility Outpatient 202 101 147.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 177 ASPIRATION BREAST 19000 CPT 96190002 CDM 520 RC Facility Outpatient 340 170 248.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133 299 ASPIRATION BREAST 19000 CPT 96190003 CDM 960 RC Facility Outpatient 340 170 248.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133 299 Biopsy of breast open/incisional 19101 CPT 97000550 CDM 520 RC Facility Outpatient 3725.02 1862.51 2719.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1713.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1467.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1974.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1713.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1541.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3278.02 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2980.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1713.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1497.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2980.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2831.02 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1713.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1713.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1467 3278 "*BREAST BIOPSY, VAC ASSW/IMG GUIDANCE" 19103 CPT 6800048 CDM 402 RC Facility Outpatient 492 246 359.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 432.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 373.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193 432 U/S NEEDLE LOCALIZATION BREAST 19290 CPT 96192902 CDM 520 RC Facility Outpatient 505 252.5 368.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 383.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198 444 U/S NEEDLE LOCALIZATION BREAST 19290 CPT 96192903 CDM 960 RC Facility Outpatient 505 252.5 368.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 383.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198 444 Exc.tumor/tissie back or flank greater t 21933 CPT 97219333 CDM 960 RC Facility Outpatient 2169 1084.5 1583.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 997.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 854.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1149.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 997.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 897.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1908.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1735.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 997.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 871.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1735.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1648.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 997.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 997.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 854 1908 *ARTHRO ANT INT BODY TECH MIN DISECTOMY 22585 CPT 97233501 CDM 960 RC Facility Outpatient 156 78 113.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 137 *ARTHRO ANT INT BODY TECH MIN DISECTOMY 22585 CPT 97233502 CDM 520 RC Facility Outpatient 156 78 113.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 137 *ARTHRO ANT INT BODY TECH MIN DISECTOMY 22585 CPT 97233503 CDM 963 RC Facility Outpatient 156 78 113.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 137 "EXC TUMOR ST OF ABD WALL,SUBCUT 3 CM GTR" 22903 CPT 97229031 CDM 960 RC Facility Outpatient 1331 665.5 971.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 705.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 550.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1171.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 534.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1011.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524 1171 "EXC TUMOR ST OF ABD WALL,SUBCUT 3 CM GTR" 22903 CPT 97229032 CDM 520 RC Facility Outpatient 1331 665.5 971.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 705.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 550.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1171.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 534.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1011.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524 1171 "EXC TUMOR ST OF ABD WALL,SUBCUT 3 CM GTR" 22903 CPT 97229033 CDM 963 RC Facility Outpatient 1331 665.5 971.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 705.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 550.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1171.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 534.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1064.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1011.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 612.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524 1171 EXC TUMOR S TISSUE UP ARM/ELBOW 3CM GRTR 24071 CPT 97240711 CDM 960 RC Facility Outpatient 1229 614.5 897.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1081.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 493.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 934.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484 1081 EXC TUMOR S TISSUE UP ARM/ELBOW 3CM GRTR 24071 CPT 97240712 CDM 520 RC Facility Outpatient 1229 614.5 897.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1081.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 493.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 934.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484 1081 EXC TUMOR S TISSUE UP ARM/ELBOW 3CM GRTR 24071 CPT 97240713 CDM 963 RC Facility Outpatient 1229 614.5 897.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1081.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 493.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 983.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 934.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 565.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 484 1081 EXC LESION OF TENDON SHEATH/JNT CAPSULE 26160 CPT 97261601 CDM 960 RC Facility Outpatient 955 477.5 697.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 506.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 840.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 383.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 725.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376 840 EXC LESION OF TENDON SHEATH/JNT CAPSULE 26160 CPT 97261602 CDM 520 RC Facility Outpatient 955 477.5 697.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 506.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 840.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 383.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 725.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376 840 EXC LESION OF TENDON SHEATH/JNT CAPSULE 26160 CPT 97261603 CDM 963 RC Facility Outpatient 955 477.5 697.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 506.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 840.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 383.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 725.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376 840 I&D PELVIS/HIP JOINT DP ABSCESS/HEMATOMA 26990 CPT 97269901 CDM 960 RC Facility Outpatient 1821 910.5 1329.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 965.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 753.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1602.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 731.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1383.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717 1602 I&D PELVIS/HIP JOINT DP ABSCESS/HEMATOMA 26990 CPT 97269902 CDM 520 RC Facility Outpatient 1821 910.5 1329.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 965.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 753.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1602.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 731.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1383.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717 1602 I&D PELVIS/HIP JOINT DP ABSCESS/HEMATOMA 26990 CPT 97269903 CDM 963 RC Facility Outpatient 1821 910.5 1329.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 965.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 753.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1602.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 731.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1383.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717 1602 EXC TUM SFT TIS PELVIS&HIP 3CM& GRTR 27043 CPT 97270432 CDM 520 RC Facility Outpatient 1416 708 1033.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1246.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 569.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1076.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557 1246 EXC TUM SFT TIS PELVIS&HIP 3CM& GRTR 27043 CPT 97270433 CDM 963 RC Facility Outpatient 1416 708 1033.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1246.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 569.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1076.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 651.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557 1246 EXC TUMOR SFT TISSUE PELVIS/HIP 5CM 27045 CPT 97270451 CDM 960 RC Facility Outpatient 2247 1123.5 1640.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1190.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 929.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1977.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 903.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1707.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885 1977 EXC TUMOR SFT TISSUE PELVIS/HIP 5CM 27045 CPT 97270452 CDM 520 RC Facility Outpatient 2247 1123.5 1640.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1190.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 929.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1977.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 903.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1707.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885 1977 EXC TUMOR SFT TISSUE PELVIS/HIP 5CM 27045 CPT 97270453 CDM 963 RC Facility Outpatient 2247 1123.5 1640.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1190.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 929.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1977.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 903.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1797.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1707.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1033.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 885 1977 "Exc tumor sft tissue back or flank, 3cm" 29131 CPT 97291311 CDM 960 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 "Exc tumor sft tissue back or flank, 3cm" 29131 CPT 97291312 CDM 520 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 "Exc tumor sft tissue back or flank, 3cm" 29131 CPT 97291313 CDM 963 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 SHORT LEG SPLINT 29515 CPT 3000175 CDM 274 RC Facility Outpatient 202 101 147.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 177 PT UNNA BOOT 15 MIN PROCEDURE 29580 CPT 9000016 CDM 420 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 INTUBATION 31500 CPT 3000147 CDM 450 RC Facility Outpatient 722 361 527.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 332.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 382.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 332.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 298.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 635.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 577.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 722 234.56 722 1 through 10 Percent of Total Billed Charges 290.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 577.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 548.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 332.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 332.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284 635 BRONCHOSCOPY RIGID FLEXIBLE 31623 CPT 97316231 CDM 960 RC Facility Outpatient 446 223 325.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 BRONCHOSCOPY FLEXIBLE/RIGID 31645 CPT 97316451 CDM 960 RC Facility Outpatient 484 242 353.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 367.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190 425 INTRODUCTION CATHETER SUPERIOR INFERIOR 36010 CPT 97360101 CDM 960 RC Facility Outpatient 382 191 278.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.46 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 305.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 305.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150 336 SEL CATH PL VENOUS SYS 2ND ORDER OR BRAN 36012 CPT 97360121 CDM 960 RC Facility Outpatient 559 279.5 408.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 491.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 424.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220 491 SEL CATH PL VENOUS SYS 2ND ORDER OR BRAN 36012 CPT 97360122 CDM 960 RC Facility Outpatient 559 279.5 408.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 491.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 424.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220 491 SEL CATH PL VENOUS SYS 2ND ORDER OR BRAN 36012 CPT 97360123 CDM 963 RC Facility Outpatient 559 279.5 408.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 491.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 424.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220 491 VENIPUNCTURE 36415 CPT 5000616 CDM 300 RC Facility Outpatient 11 5.5 73 4.95 4.95 4.95 1 through 10 Percent of Total Billed Charges 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 8.8 4.56 8.86 24 Percent of Total Billed Charges 53 4.56 4.56 4.56 34 Percent of Total Billed Charges 4.79 4.79 4.79 1 through 10 Percent of Total Billed Charges 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 11 11 22 1 through 10 Percent of Total Billed Charges 53 11 11 11 125 Percent of Total Billed Charges 100 9.97 100 25 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 9.35 4.84 9.35 32 Percent of Total Billed Charges 53 5.06 4.84 5.83 303 Percent of Total Billed Charges 53 4.56 4.56 4.71 36 Percent of Total Billed Charges 4 9 BB TRANSFUSION BLOOD/BLOOD COMPONENTS 36430 CPT 3000173 CDM 391 RC Facility Outpatient 868 434 633.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 341.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 839.59 839.59 839.59 1 through 10 Percent of Total Billed Charges 399.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 359.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 729.99 729.99 729.99 1 through 10 Percent of Total Billed Charges 694.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 868 868 868 1 through 10 Percent of Total Billed Charges 348.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 694.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 659.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 460.04 381.92 460.04 1 through 10 Percent of Total Billed Charges 399.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 341 694 CVD INS PERIPHERALLY W/SUBCU PORT OVER 5 36571 CPT 97365711 CDM 960 RC Facility Outpatient 1004 502 732.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 532.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 415.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 883.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 763.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395 883 CVD INS PERIPHERALLY W/SUBCU PORT OVER 5 36571 CPT 97365712 CDM 960 RC Facility Outpatient 1004 502 732.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 532.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 415.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 883.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 763.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395 883 CVD INS PERIPHERALLY W/SUBCU PORT OVER 5 36571 CPT 97365713 CDM 960 RC Facility Outpatient 1004 502 732.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 532.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 415.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 883.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 763.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395 883 "CVC;REMOVAL,TUNNELED,NO PORT/NO PUMP" 36589 CPT 97365893 CDM 963 RC Facility Outpatient 472 236 344.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 415.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185 415 BX or EX of lymph nodes by needle superf 38505 CPT 97385051 CDM 960 RC Facility Outpatient 219 109.5 159.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BX or EX of lymph nodes by needle superf 38505 CPT 97385052 CDM 520 RC Facility Outpatient 219 109.5 159.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BX or EX of lymph nodes by needle superf 38505 CPT 97385053 CDM 963 RC Facility Outpatient 219 109.5 159.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BIOPSY/EXCISION LYMPH NODE BY NEEDLE 38505 CPT 98001016 CDM 520 RC Facility Outpatient 221 110.5 161.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 194 Diverticulectomy of hypopharynx/eso w/wo 43130 CPT 97431301 CDM 960 RC Facility Outpatient 2395 1197.5 1748.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1269.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 990.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2107.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 962.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1820.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943 2107 Diverticulectomy of hypopharynx/eso w/wo 43130 CPT 97431302 CDM 520 RC Facility Outpatient 2395 1197.5 1748.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1269.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 990.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2107.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 962.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1820.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943 2107 Diverticulectomy of hypopharynx/eso w/wo 43130 CPT 97431303 CDM 963 RC Facility Outpatient 2395 1197.5 1748.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1269.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 990.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2107.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 962.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1916 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1820.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1101.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943 2107 UPPER GI ENDO W/CNTRL BLEEDING ANY METHO 43255 CPT 97432551 CDM 960 RC Facility Outpatient 865 432.5 631.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 458.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 357.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 761.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340 761 UPPER GI ENDO W/CNTRL BLEEDING ANY METHO 43255 CPT 97432552 CDM 520 RC Facility Outpatient 865 432.5 631.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 458.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 357.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 761.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340 761 UPPER GI ENDO W/CNTRL BLEEDING ANY METHO 43255 CPT 97432553 CDM 963 RC Facility Outpatient 865 432.5 631.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 458.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 357.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 761.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 692 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340 761 UPPER GI ENDOSCOPY INCLUDING ESOPHAGUS 43256 CPT 97432561 CDM 960 RC Facility Outpatient 780 390 569.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 413.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 322.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 686.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 624 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 313.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 624 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 592.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307 686 EXC LOCAL ULCER/BENIGN TUMOR OF STOMACH 43610 CPT 97436101 CDM 960 RC Facility Outpatient 2885 1442.5 2106.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1529.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1193.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2538.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1159.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2192.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136 2538 EXC LOCAL ULCER/BENIGN TUMOR OF STOMACH 43610 CPT 97436102 CDM 520 RC Facility Outpatient 2885 1442.5 2106.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1529.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1193.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2538.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1159.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2192.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136 2538 EXC LOCAL ULCER/BENIGN TUMOR OF STOMACH 43610 CPT 97436103 CDM 963 RC Facility Outpatient 2885 1442.5 2106.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1529.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1193.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2538.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1159.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2308 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2192.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1327.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1136 2538 "GASTRORRHAPHY,SUTURE PERF DUODENAL ULCER" 43840 CPT 97438401 CDM 960 RC Facility Outpatient 3971 1985.5 2898.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2104.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1642.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3494.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1595.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3017.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564 3494 "GASTRORRHAPHY,SUTURE PERF DUODENAL ULCER" 43840 CPT 97438402 CDM 520 RC Facility Outpatient 3971 1985.5 2898.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2104.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1642.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3494.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1595.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3017.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564 3494 "GASTRORRHAPHY,SUTURE PERF DUODENAL ULCER" 43840 CPT 97438403 CDM 963 RC Facility Outpatient 3971 1985.5 2898.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2104.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1642.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3494.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1595.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3017.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1826.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1564 3494 CLOSURE OF GASTROCOLIC FISTULA 43880 CPT 97438801 CDM 960 RC Facility Outpatient 4705 2352.5 3434.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2493.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1946.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4140.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1890.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3575.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853 4140 CLOSURE OF GASTROCOLIC FISTULA 43880 CPT 97438802 CDM 520 RC Facility Outpatient 4705 2352.5 3434.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2493.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1946.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4140.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1890.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3575.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853 4140 CLOSURE OF GASTROCOLIC FISTULA 43880 CPT 97438803 CDM 963 RC Facility Outpatient 4705 2352.5 3434.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2493.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1946.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4140.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1890.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3764 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3575.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2164.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853 4140 ENTERECTOMY RESECTION SMALL INTESTINE W. 44125 CPT 97441251 CDM 960 RC Facility Outpatient 3478 1739 2538.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1599.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1370.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1843.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1599.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1438.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3060.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1599.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1397.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2782.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2643.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1599.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1599.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1370 3060 Enteroenterostomy anastomosis intestine 44130 CPT 97441301 CDM 960 RC Facility Outpatient 3837 1918.5 2801.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1765.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1511.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2033.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1765.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1587.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3376.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3069.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1765.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1542.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3069.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2916.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1765.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1765.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1511 3376 "Laparoscopy,surg,take down splenic flexu" 44213 CPT 97442131 CDM 960 RC Facility Outpatient 565 282.5 412.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 497.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 429.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222 497 "Laparoscopy,surg,take down splenic flexu" 44213 CPT 97442132 CDM 520 RC Facility Outpatient 565 282.5 412.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 497.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 429.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222 497 "Laparoscopy,surg,take down splenic flexu" 44213 CPT 97442133 CDM 963 RC Facility Outpatient 565 282.5 412.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 497.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 429.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222 497 PLACEMENT ENTEROSTOMY/CECOTOMY TUBE OPEN 44300 CPT 97443001 CDM 960 RC Facility Outpatient 2478 1239 1808.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1139.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 976.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1313.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1139.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1025.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2180.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1982.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1139.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 995.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1982.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1883.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1139.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1139.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 976 2180 IIEOSTOMY OR JEJUNOSTOMY NONTUBE 44310 CPT 97443101 CDM 960 RC Facility Outpatient 3076 1538 2245.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1414.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1211.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1630.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1414.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1272.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2706.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2460.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1414.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1236.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2460.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2337.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1414.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1414.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1211 2706 SUTURE LARGE INTESTINE PERFORATED ULCER 44604 CPT 97446041 CDM 960 RC Facility Outpatient 3123 1561.5 2279.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1436.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1230.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1655.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1436.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1291.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2748.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2498.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1436.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1255.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2498.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2373.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1436.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1436.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1230 2748 "Closure of Enterostomy, LG/SM Intestine" 44620 CPT 97446201 CDM 960 RC Facility Outpatient 2548 1274 1860.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1350.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1054.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2242.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1023.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1936.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003 2242 "Closure of Enterostomy, LG/SM Intestine" 44620 CPT 97446202 CDM 520 RC Facility Outpatient 2548 1274 1860.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1350.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1054.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2242.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1023.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1936.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003 2242 "Closure of Enterostomy, LG/SM Intestine" 44620 CPT 97446203 CDM 963 RC Facility Outpatient 2548 1274 1860.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1350.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1054.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2242.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1023.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1936.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1172.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1003 2242 Closure enterovesical fistula w/ resecti 44661 CPT 97446611 CDM 960 RC Facility Outpatient 4627 2313.5 3377.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1823.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2452.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1914.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4071.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1859.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3516.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1823 4071 Closure enterovesical fistula w/ resecti 44661 CPT 97446612 CDM 520 RC Facility Outpatient 4627 2313.5 3377.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1823.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2452.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1914.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4071.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1859.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3516.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2128.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1823 4071 EXC RECTAL TUMOR TRANSANAL APP NOT INC 45171 CPT 97451711 CDM 960 RC Facility Outpatient 1788 894 1305.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 822.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 704.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 947.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 822.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 739.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1573.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1430.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 822.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 718.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1430.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1358.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 822.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 822.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 704 1573 Proctosigmoidoscopy/diagnostic 45300 CPT 97005631 CDM 960 RC Facility Outpatient 838.4 419.2 612.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 330.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 737.79 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 670.72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 670.72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 637.18 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 330 737 PROCTOSIGMOID-RIGID-REM FOREIGN BODY 45307 CPT 97453071 CDM 960 RC Facility Outpatient 301 150.5 219.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 264 PROCTOSIGMOID-RIGID-REM FOREIGN BODY 45307 CPT 97453072 CDM 520 RC Facility Outpatient 301 150.5 219.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 264 PROCTOSIGMOID-RIGID-REM FOREIGN BODY 45307 CPT 97453073 CDM 963 RC Facility Outpatient 301 150.5 219.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 240.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 264 COLONSCOPY WITH INJECTION 45381 CPT 97453811 CDM 960 RC Facility Outpatient 753 376.5 549.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 311.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 662.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 302.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 572.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 662 COLONSCOPY WITH INJECTION 45381 CPT 97453812 CDM 520 RC Facility Outpatient 753 376.5 549.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 311.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 662.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 302.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 572.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 662 COLONSCOPY WITH INJECTION 45381 CPT 97453813 CDM 963 RC Facility Outpatient 753 376.5 549.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 311.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 662.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 302.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 572.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 662 COLONSCOPY WITH INJECTION 45381 CPT 97453823 CDM 963 RC Facility Outpatient 753 376.5 549.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 311.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 662.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 302.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 572.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 662 COLONOSCOPY WITH POLYPECTOMY SINGLE 45385 CPT 2800001 CDM 750 RC Facility Outpatient 1785 892.5 1303.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 821.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 703.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 946.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 821.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 738.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1570.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1428 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 821.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 717.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1428 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1356.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 821.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 821.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 703 1570 PROCTOPEXY PERINEAL APPROACH 45541 CPT 97455411 CDM 960 RC Facility Outpatient 2707 1353.5 1976.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1245.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1066.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1434.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1245.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1119.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2382.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1245.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1087.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2057.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1245.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1245.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1066 2382 I & D ABCESS-PERIRECTAL 46040 CPT 97460403 CDM 963 RC Facility Outpatient 1200 600 876 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 472.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 636 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 496.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1056 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 960 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 482.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 960 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 472 1056 "EXC SINGLE EXT PAPILLA OR TAG,ANAL" 46220 CPT 97462201 CDM 960 RC Facility Outpatient 343 171.5 250.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 301 "EXC SINGLE EXT PAPILLA OR TAG,ANAL" 46220 CPT 97462202 CDM 520 RC Facility Outpatient 343 171.5 250.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 301 "EXC SINGLE EXT PAPILLA OR TAG,ANAL" 46220 CPT 97462203 CDM 963 RC Facility Outpatient 343 171.5 250.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 301 "Injection of sclerosing solution, hemorr" 46500 CPT 98001013 CDM 520 RC Facility Outpatient 2474 1237 1806.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1138.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 974.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1311.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1138.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1023.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2177.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1979.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1138.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 994.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1979.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1880.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1138.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1138.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 974 2177 ANOSCOPY W BIOPSY SINGLE/MULTIPLE 46606 CPT 98001010 CDM 520 RC Facility Outpatient 219 109.5 159.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 "Anoscopy; with biopsy, single or multipl" 46606 CPT 98001014 CDM 520 RC Facility Outpatient 1012 506 738.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 536.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 418.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 890.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 809.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 406.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 809.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 769.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398 890 "BIOPSY LIVER,NEEDLE;PERCUTANEOUS" 47000 CPT 97470001 CDM 960 RC Facility Outpatient 298 149 217.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 262 "BIOPSY LIVER,NEEDLE;PERCUTANEOUS" 47000 CPT 97470002 CDM 520 RC Facility Outpatient 298 149 217.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 262 "BIOPSY LIVER,NEEDLE;PERCUTANEOUS" 47000 CPT 97470003 CDM 963 RC Facility Outpatient 298 149 217.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 262 LAPAROSCOPY CHOLECYSTECTOMY 47562 CPT 97000126 CDM 960 RC Facility Outpatient 2281 1140.5 1665.13 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 898.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1208.93 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 943.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2007.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1824.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 916.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1824.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1733.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1049.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 898 2007 EXPLORATION RETROPERITONEAL AREA W/WO BI 49010 CPT 97490101 CDM 960 RC Facility Outpatient 2789 1394.5 2035.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1282.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1098.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1478.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1282.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1153.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2454.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2231.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1282.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1120.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2231.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2119.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1282.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1282.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1098 2454 "EXC/DES OPEN INTRA ABD TUM,CYS OR ENDO" 49204 CPT 97492041 CDM 960 RC Facility Outpatient 4504 2252 3287.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2387.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1863.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3963.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1810.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3423.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774 3963 "EXC/DES OPEN INTRA ABD TUM,CYS OR ENDO" 49204 CPT 97492042 CDM 520 RC Facility Outpatient 4504 2252 3287.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2387.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1863.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3963.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1810.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3423.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774 3963 "EXC/DES OPEN INTRA ABD TUM,CYS OR ENDO" 49204 CPT 97492043 CDM 963 RC Facility Outpatient 4504 2252 3287.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2387.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1863.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3963.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1810.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3603.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3423.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2071.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1774 3963 UMBILECTOMY/OMPHAL/EXC OF UMBILICUS SEP 49250 CPT 97492501 CDM 960 RC Facility Outpatient 1708 854 1246.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 905.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 706.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1503.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 686.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1298.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672 1503 UMBILECTOMY/OMPHAL/EXC OF UMBILICUS SEP 49250 CPT 97492502 CDM 520 RC Facility Outpatient 1708 854 1246.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 905.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 706.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1503.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 686.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1298.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672 1503 UMBILECTOMY/OMPHAL/EXC OF UMBILICUS SEP 49250 CPT 97492503 CDM 963 RC Facility Outpatient 1708 854 1246.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 905.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 706.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1503.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 686.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1366.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1298.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 785.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 672 1503 OMENTECTOMY/EPIPLOETOMY/RES OMEN/SEP PRO 49255 CPT 97492551 CDM 960 RC Facility Outpatient 2317 1158.5 1691.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1228.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 958.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 931.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1760.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912 2038 OMENTECTOMY/EPIPLOETOMY/RES OMEN/SEP PRO 49255 CPT 97492552 CDM 520 RC Facility Outpatient 2317 1158.5 1691.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1228.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 958.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 931.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1760.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912 2038 OMENTECTOMY/EPIPLOETOMY/RES OMEN/SEP PRO 49255 CPT 97492553 CDM 963 RC Facility Outpatient 2317 1158.5 1691.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1228.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 958.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2038.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 931.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1853.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1760.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1065.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 912 2038 REM TUNNELED INTRAPERITONEAL CATHETER 49422 CPT 49494221 CDM 960 RC Facility Outpatient 1137 568.5 830.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 470.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1000.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 456.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 864.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447 1000 REM TUNNELED INTRAPERITONEAL CATHETER 49422 CPT 49494222 CDM 520 RC Facility Outpatient 1137 568.5 830.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 470.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1000.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 456.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 864.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447 1000 REM TUNNELED INTRAPERITONEAL CATHETER 49422 CPT 49494223 CDM 963 RC Facility Outpatient 1137 568.5 830.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 602.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 470.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1000.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 456.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 909.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 864.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 523.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447 1000 INS GASTROSTOMY TUBE FLUORO GUIDANCE 49440 CPT 97494401 CDM 960 RC Facility Outpatient 697 348.5 508.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 613.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 280.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 529.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274 613 INS GASTROSTOMY TUBE FLUORO GUIDANCE 49440 CPT 97494403 CDM 963 RC Facility Outpatient 697 348.5 508.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 613.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 280.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 529.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274 613 INS GASTROSTOMY TUBE FLUORO GUIDANCE 49440 CPT 97499401 CDM 520 RC Facility Outpatient 697 348.5 508.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 613.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 280.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 529.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274 613 CONVS G-TUBE TO GASTROJEJUNOSTOMY TUBE 49446 CPT 97494461 CDM 960 RC Facility Outpatient 514 257 375.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 390.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202 452 CONVS G-TUBE TO GASTROJEJUNOSTOMY TUBE 49446 CPT 97494462 CDM 520 RC Facility Outpatient 514 257 375.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 390.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202 452 CONVS G-TUBE TO GASTROJEJUNOSTOMY TUBE 49446 CPT 97494463 CDM 963 RC Facility Outpatient 514 257 375.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 390.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202 452 LAPAROSCOPY SURG REPAIR RCR INC HERNIA 49656 CPT 97496561 CDM 960 RC Facility Outpatient 2501 1250.5 1825.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1325.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1034.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2200.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1005.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1900.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985 2200 LAPAROSCOPY SURG REPAIR RCR INC HERNIA 49656 CPT 97496562 CDM 520 RC Facility Outpatient 2501 1250.5 1825.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1325.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1034.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2200.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1005.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1900.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985 2200 LAPAROSCOPY SURG REPAIR RCR INC HERNIA 49656 CPT 97496563 CDM 963 RC Facility Outpatient 2501 1250.5 1825.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1325.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1034.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2200.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1005.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2000.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1900.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 985 2200 INSERT NON-INDWELLING BLADDER CATH 51701 CPT 3000176 CDM 450 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 INSERTION OF TEMPORARY INDW BLADDER CATH 51702 CPT 3000174 CDM 450 RC Facility Outpatient 250 125 182.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 103.68 103.68 103.68 1 through 10 Percent of Total Billed Charges 115 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 200 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115 110 132.5 1 through 10 Percent of Total Billed Charges 115 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 "SALPINGECTOMY,COMPLETE OR PARTIAL" 58700 CPT 97587001 CDM 960 RC Facility Outpatient 2332 1166 1702.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1235.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 964.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2052.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 937.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1772.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918 2052 "SALPINGECTOMY,COMPLETE OR PARTIAL" 58700 CPT 97587002 CDM 520 RC Facility Outpatient 2332 1166 1702.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1235.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 964.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2052.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 937.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1772.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918 2052 "SALPINGECTOMY,COMPLETE OR PARTIAL" 58700 CPT 97587003 CDM 963 RC Facility Outpatient 2332 1166 1702.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1235.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 964.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2052.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 937.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1865.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1772.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1072.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 918 2052 REM SUBCU RESVR/PUMP PREV IMPL INTRA/INF 62365 CPT 97623651 CDM 960 RC Facility Outpatient 967 483.5 705.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 850.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 388.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 734.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 850 REM SUBCU RESVR/PUMP PREV IMPL INTRA/INF 62365 CPT 97623652 CDM 520 RC Facility Outpatient 967 483.5 705.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 850.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 388.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 734.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 850 REM SUBCU RESVR/PUMP PREV IMPL INTRA/INF 62365 CPT 97623653 CDM 963 RC Facility Outpatient 967 483.5 705.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 850.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 388.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 773.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 734.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381 850 MANDIBLE LESS THAN 4 VIEWS 70100 CPT 6000237 CDM 324 RC Facility Outpatient 206 103 150.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 181 SINUSES LESS THAN 3 VIEWS 70210 CPT 6000238 CDM 324 RC Facility Outpatient 173 86.5 126.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 152 TMJ UNILATERAL 70328 CPT 6000239 CDM 324 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 CT HEAD WO 70450 CPT 6000230 CDM 351 RC Facility Outpatient 1213 606.5 73 885.49 642.89 885.49 1 through 10 Percent of Total Billed Charges 53 642.89 321.45 642.89 1 through 10 Percent of Total Billed Charges 477.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 503.03 125.88 503.03 1 through 10 Percent of Total Billed Charges 53 503.03 503.03 503.03 1 through 10 Percent of Total Billed Charges 506.4 506.4 506.4 1 through 10 Percent of Total Billed Charges 88 1020.13 1020.13 1020.13 1 through 10 Percent of Total Billed Charges 80 341 341 341 1 through 10 Percent of Total Billed Charges 53 86.6 42.88 392.6 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 970.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 1031.05 1031.05 1031.05 1 through 10 Percent of Total Billed Charges 53 557.98 533.72 642.89 28 Percent of Total Billed Charges 53 519.89 503.03 519.89 1 through 10 Percent of Total Billed Charges 477 970 CT FACE WWO CONTRAST 70488 CPT 6000231 CDM 324 RC Facility Outpatient 1661 830.5 1212.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 654.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 880.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 687.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1461.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1328.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 667.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1328.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1262.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 764.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 654 1461 CT NECK WWO CONTRAST 70492 CPT 6000218 CDM 351 RC Facility Outpatient 1419 709.5 1035.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 559.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 752.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 587.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1248.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 570.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1078.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 652.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 559 1248 CHEST SPECIAL VIEWS (DECUB) 71045 CPT 6000248 CDM 324 RC Facility Outpatient 129 64.5 73 94.17 68.37 94.17 1 through 10 Percent of Total Billed Charges 53 68.37 68.37 68.37 13 Percent of Total Billed Charges 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53.5 31.75 103.94 1 through 10 Percent of Total Billed Charges 53 53.5 53.5 62.2 1 through 10 Percent of Total Billed Charges 53.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 108.49 108.49 108.49 1 through 10 Percent of Total Billed Charges 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 129 129 129 1 through 10 Percent of Total Billed Charges 51.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 56.76 56.76 109.65 1 through 10 Percent of Total Billed Charges 53 56.76 56.76 68.37 36 Percent of Total Billed Charges 53 55.29 53.5 55.29 1 through 10 Percent of Total Billed Charges 50 103 CT THORAX LOW DOSE WO CONTRAST 71271 CPT 6400064 CDM 352 RC Facility Outpatient 240 120 175.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 127.2 127.2 127.2 1 through 10 Percent of Total Billed Charges 94.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 99.53 99.53 99.53 1 through 10 Percent of Total Billed Charges 99.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 240 105.6 240 1 through 10 Percent of Total Billed Charges 96.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 127.2 127.2 127.2 1 through 10 Percent of Total Billed Charges 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 211 SPINE CERVICAL FLEX AND EXT 72052 CPT 6000229 CDM 324 RC Facility Outpatient 448 224 327.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 358.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 394 RADIOLOGIC EXAM SCOLIOSIS EVAL 72081 CPT 6000250 CDM 324 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 209 CT L-SPINE W/CONTRAST 72132 CPT 6400039 CDM 351 RC Facility Outpatient 1487 743.5 1085.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 684.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 788.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 684.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 615.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1308.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 684.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 597.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1130.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 684.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 684.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585 1308 CT ABDOMEN AND PELVIS WO 74176 CPT 6400059 CDM 352 RC Facility Outpatient 2266 1133 73 1654.18 1200.98 1654.18 1 through 10 Percent of Total Billed Charges 53 1200.98 1200.98 1200.98 1 through 10 Percent of Total Billed Charges 892.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 939.71 220.25 1825.72 1 through 10 Percent of Total Billed Charges 53 939.71 939.71 939.71 1 through 10 Percent of Total Billed Charges 946.01 946.01 946.01 1 through 10 Percent of Total Billed Charges 88 1905.71 1905.71 1905.71 1 through 10 Percent of Total Billed Charges 80 997.04 962.31 997.04 1 through 10 Percent of Total Billed Charges 53 727.6 413.3 1132.08 1 through 10 Percent of Total Billed Charges 918.98 918.98 918.98 1 through 10 Percent of Total Billed Charges 1812.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1722.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 997.04 997.04 1200.98 17 Percent of Total Billed Charges 53 939.71 939.71 971.21 1 through 10 Percent of Total Billed Charges 892 1812 CT ABDOMEN AND PELVIS W CONTRAST 74177 CPT 6400060 CDM 352 RC Facility Outpatient 2575 1287.5 1879.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1184.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1014.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1364.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1067.85 1067.85 1067.85 1 through 10 Percent of Total Billed Charges 1065.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2266 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2060 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1236.18 1236.18 1236.18 1 through 10 Percent of Total Billed Charges 100 9.97 1044.29 1 through 10 Percent of Total Billed Charges 2060 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1957 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1364.75 1184.5 1364.75 1 through 10 Percent of Total Billed Charges 1184.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1014 2266 CT ABDOMEN AND PELVIS WWO CONTRAST 74178 CPT 6400061 CDM 352 RC Facility Outpatient 2987 1493.5 2180.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1374.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1176.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1583.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1374.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1235.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2628.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2389.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1374.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1200.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2389.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2270.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1374.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1374.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1176 2628 *UGI W/ SBFT 74245 CPT 6000242 CDM 324 RC Facility Outpatient 548 274 400.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 482.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 416.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215 482 US RENAL/AORTA LIMITED 76775 CPT 6800052 CDM 402 RC Facility Outpatient 348 174 254.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 306.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 153.12 153.12 153.12 1 through 10 Percent of Total Billed Charges 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137 306 US PREG 1ST TRI EA ADD GEST 76802 CPT 6800045 CDM 402 RC Facility Outpatient 319 159.5 232.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 280.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 242.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125 280 "US PREG LIMITED (HB, PLACENTA, POS)" 76815 CPT 6800046 CDM 402 RC Facility Outpatient 264 132 192.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 232 US PREG TRANSVAGINAL 76817 CPT 6800047 CDM 402 RC Facility Outpatient 287 143.5 209.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113 252 *US TRANSRECTAL 76872 CPT 6800044 CDM 402 RC Facility Outpatient 302 151 220.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 265 US GUIDANCE VASCULAR ACCESS 76937 CPT 6800051 CDM 402 RC Facility Outpatient 136 68 99.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119 US GUIDANCE INTRAOPERATIVE 76998 CPT 6800053 CDM 402 RC Facility Outpatient 136 68 99.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119 BONE SURVEY COMPLETE 77075 CPT 6000243 CDM 324 RC Facility Outpatient 1008 504 735.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 534.24 534.24 534.24 1 through 10 Percent of Total Billed Charges 397.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 534.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 463.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 887.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 806.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 463.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 405.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 806.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 766.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 463.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 463.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397 887 BONE SURVEY INFANT 77076 CPT 6000244 CDM 324 RC Facility Outpatient 361 180.5 263.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142 317 SCHILLINGS STAGE I 78270 CPT 5000046 CDM 341 RC Facility Outpatient 200 100 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 SCHILLINGS STAGE 1 78270 CPT 5400049 CDM 341 RC Facility Outpatient 65 32.5 47.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 SCHILLING STAGE II 78271 CPT 5000562 CDM 341 RC Facility Outpatient 252 126 183.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99 221 BASIC METABOLIC PANEL 80048 CPT 5000492 CDM 301 RC Facility Outpatient 98 49 73 51.94 51.94 51.94 1 through 10 Percent of Total Billed Charges 53 51.94 51.94 51.94 13 Percent of Total Billed Charges 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 23.08 11.54 40.64 1 through 10 Percent of Total Billed Charges 53 40.64 40.64 47.25 11 Percent of Total Billed Charges 8.88 8.88 8.88 1 through 10 Percent of Total Billed Charges 88 82.42 82.42 82.42 1 through 10 Percent of Total Billed Charges 80 14.34 14.34 14.34 1 through 10 Percent of Total Billed Charges 53 98 3.92 98 17 Percent of Total Billed Charges 100 9.97 100 1 through 10 Percent of Total Billed Charges 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 83.3 43.12 86.24 1 through 10 Percent of Total Billed Charges 53 51.94 43.12 51.94 91 Percent of Total Billed Charges 53 40.64 40.64 42 1 through 10 Percent of Total Billed Charges 38 78 GENERAL HEALTH PANEL 80050 CPT 5000071 CDM 301 RC Facility Outpatient 228 114 166.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 200 ELECTROLYTE PANEL 80051 CPT 5000375 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 COMP METABOLIC PANEL 80053 CPT 5000072 CDM 301 RC Facility Outpatient 125 62.5 73 91.25 66.25 91.25 36 Percent of Total Billed Charges 53 66.25 66.25 66.25 49 Percent of Total Billed Charges 49.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 51.84 14.41 100.71 1 through 10 Percent of Total Billed Charges 53 51.84 51.84 51.84 18 Percent of Total Billed Charges 11.09 11.09 75.01 1 through 10 Percent of Total Billed Charges 88 105.13 105.13 105.13 11 Percent of Total Billed Charges 80 125 125 125 1 through 10 Percent of Total Billed Charges 53 125 48.84 125 75 Percent of Total Billed Charges 13.56 10.86 100 18 Percent of Total Billed Charges 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 66.25 55 106.25 24 Percent of Total Billed Charges 53 57.5 55 66.25 194 Percent of Total Billed Charges 53 51.84 51.84 53.58 24 Percent of Total Billed Charges 49 100 OBSTETRIC PANEL 80055 CPT 5000073 CDM 301 RC Facility Outpatient 355 177.5 259.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139 312 LIPID PROFILE 80061 CPT 5000482 CDM 301 RC Facility Outpatient 127 63.5 73 92.71 92.71 92.71 23 Percent of Total Billed Charges 53 67.31 67.31 67.31 19 Percent of Total Billed Charges 50.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.27 18.27 18.27 1 through 10 Percent of Total Billed Charges 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.06 14.06 14.06 1 through 10 Percent of Total Billed Charges 88 106.81 106.81 106.81 1 through 10 Percent of Total Billed Charges 80 71.76 44.92 71.76 1 through 10 Percent of Total Billed Charges 53 56.92 13.24 127 27 Percent of Total Billed Charges 17.19 17.19 17.19 1 through 10 Percent of Total Billed Charges 101.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 67.31 55.88 107.95 15 Percent of Total Billed Charges 53 58.42 55.88 67.31 66 Percent of Total Billed Charges 53 52.67 52.67 54.43 11 Percent of Total Billed Charges 50 101 RENAL FUNCTION PANEL 80069 CPT 5000635 CDM 301 RC Facility Outpatient 114 57 83.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 50.16 50.16 50.16 1 through 10 Percent of Total Billed Charges 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 100 HEPATITIS PROFILE ABC ACUTE I 80074 CPT 5000087 CDM 301 RC Facility Outpatient 345 172.5 251.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 303.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 303 ACUTE HEPATITIS PANEL 80074 CPT 5000119 CDM 301 RC Facility Outpatient 293 146.5 213.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 257 HEPATIC FUNCTION PANEL 80076 CPT 5000426 CDM 301 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 46.86 11.14 46.86 1 through 10 Percent of Total Billed Charges 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 113 67.96 113 1 through 10 Percent of Total Billed Charges 10.49 10.49 10.49 1 through 10 Percent of Total Billed Charges 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 51.98 32 96.05 1 through 10 Percent of Total Billed Charges 53 48.44 46.86 48.44 1 through 10 Percent of Total Billed Charges 44 99 TRICYCLIC LEVEL 80101 CPT 5000734 CDM 300 RC Facility Outpatient 137 68.5 100.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 120 NARCOTIC URINE QUANT 80102 CPT 5400112 CDM 301 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 AMIKACIN RANDOM 80150 CPT 5000240 CDM 301 RC Facility Outpatient 98 49 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 ELAVIL SERUM 80152 CPT 5000093 CDM 301 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 ELAVIL - SERUM (AMITRI) 80152 CPT 5400091 CDM 301 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 CLOZARIL LEVEL 80154 CPT 5400037 CDM 301 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 TEGRETOL 80156 CPT 5000582 CDM 301 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 CYCLOSPORINE (SENS DISC) 80158 CPT 5000016 CDM 306 RC Facility Outpatient 114 57 83.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 100 CYCLOSPORINE 80158 CPT 5000354 CDM 301 RC Facility Outpatient 127 63.5 92.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 111 CYCLOSPORINE 80158 CPT 5400013 CDM 301 RC Facility Outpatient 34 17 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 DIGOXIN 80162 CPT 5000629 CDM 301 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.99 36.52 43.99 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 VALPROIC ACID 80164 CPT 5000099 CDM 301 RC Facility Outpatient 102 51 74.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 89 GENTAMICIN RANDOM 80170 CPT 5000405 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 GENT PEAK 80170 CPT 5000638 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 GENT TROUGH 80170 CPT 5000639 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 VANC PEAK 80170 CPT 5000640 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 VANC TROUGH 80170 CPT 5000641 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 HALOPERIDOL 80173 CPT 5000414 CDM 301 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 99 IMPRAMINE - TAFRANIL 80174 CPT 5000095 CDM 301 RC Facility Outpatient 77 38.5 56.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 67 TOFRANIL LEVEL 80174 CPT 5400032 CDM 301 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 IMIPRAMINE 80174 CPT 5400093 CDM 301 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 LIDOCAINE 80176 CPT 5000480 CDM 301 RC Facility Outpatient 174 87 127.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 153 LITHIUM 80178 CPT 5000484 CDM 301 RC Facility Outpatient 100 50 73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 100 100 100 1 through 10 Percent of Total Billed Charges 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 PAMELOR LVL NORTRIPTYLINE 80182 CPT 5000517 CDM 301 RC Facility Outpatient 57 28.5 41.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 10-HYDROXYCARBAZEPINE 80183 CPT 5000172 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 PHENYTOIN 80185 CPT 5000359 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 PRIMIDONE 80188 CPT 5000530 CDM 301 RC Facility Outpatient 115 57.5 83.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 101 PROCAINAMIDE 80190 CPT 5000531 CDM 301 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 QUINIDINE 80194 CPT 5000543 CDM 301 RC Facility Outpatient 89 44.5 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 SIROLIMUS 80195 CPT 5001000 CDM 301 RC Facility Outpatient 191 95.5 139.43 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.23 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 168 PROGRAF LEVEL 80197 CPT 5000150 CDM 301 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 238 238 238 1 through 10 Percent of Total Billed Charges 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 209 TACROLIMUS IMMUNOASSAY 80197 CPT 5000865 CDM 301 RC Facility Outpatient 201 100.5 146.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 238 238 238 1 through 10 Percent of Total Billed Charges 80.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 176 THEOPHYLLINE 80198 CPT 5000630 CDM 301 RC Facility Outpatient 106 53 77.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 93 TOBRAMYCIN RANDOM 80200 CPT 5000592 CDM 301 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 TOBRAMYCIN TROUGH 80200 CPT 5000717 CDM 301 RC Facility Outpatient 115 57.5 83.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 101 TOPIRAMATE LEVEL 80201 CPT 5000699 CDM 301 RC Facility Outpatient 168 84 122.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 147 VANCOMYCIN RANDOM 80202 CPT 5000615 CDM 301 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 VIMPAT LEVEL 80235 CPT 5000895 CDM 310 RC Facility Outpatient 225 112.5 164.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 198 SERUM LAMOTRIGINE LEVEL BY HLPC 80299 CPT 5000171 CDM 301 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 AMINDCROME LEVEL 80299 CPT 5000241 CDM 301 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 AMIODARONE 80299 CPT 5000244 CDM 301 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 ATIRAN 80299 CPT 5000263 CDM 301 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 DILTIAZEM LEVEL 80299 CPT 5000360 CDM 301 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 DISOPYRAMIDE 80299 CPT 5000362 CDM 301 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 FELBAMATE 80299 CPT 5000391 CDM 301 RC Facility Outpatient 209 104.5 152.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82 183 MEXILETINE LEVEL 80299 CPT 5000494 CDM 301 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 NEURONTIN 80299 CPT 5000505 CDM 301 RC Facility Outpatient 147 73.5 107.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 129 PAROXETINE 80299 CPT 5000520 CDM 301 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 PROLIXIN 80299 CPT 5000534 CDM 301 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 PROMETHAZINE 80299 CPT 5000535 CDM 301 RC Facility Outpatient 95 47.5 69.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 83 SERTRALINE 80299 CPT 5000566 CDM 301 RC Facility Outpatient 299 149.5 218.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 263.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 263 THIOTHIXENE 80299 CPT 5000584 CDM 301 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 TRIFLUOPERAZINE 80299 CPT 5000600 CDM 301 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 VERAPAMIL SERUM 80299 CPT 5000617 CDM 301 RC Facility Outpatient 102 51 74.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 89 WELLBUTRIN 80299 CPT 5000623 CDM 301 RC Facility Outpatient 237 118.5 173.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 208 DIPHENHYDRAMINE LEVEL 80299 CPT 5000636 CDM 301 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 .DRUG SCREEN SAP10 80303 CPT 5000029 CDM 301 RC Facility Outpatient 178 89 129.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70 156 .MARIJUANA URINE 80303 CPT 5000098 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 NARCOTIC URINE-QUANT 80303 CPT 5000112 CDM 301 RC Facility Outpatient 370 185 270.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 325.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145 325 COMP DRUG SCR-GASTRIC FLUID 80303 CPT 5000307 CDM 301 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 .DRUG SCREEN ADV AMB 80303 CPT 5000367 CDM 301 RC Facility Outpatient 40 20 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 .DRUG SER MODIFIED URINE 80303 CPT 5000371 CDM 301 RC Facility Outpatient 192 96 140.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 168 NARCOTIC URINE-QUAL 80303 CPT 5000504 CDM 301 RC Facility Outpatient 200 100 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 NIDA SCREEN 80303 CPT 5000509 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 SERUM DRUG SCREEN 80303 CPT 5000567 CDM 301 RC Facility Outpatient 379 189.5 276.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 303.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 303.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149 333 THC METAB GCLMS V 80303 CPT 5000583 CDM 301 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 .TRICYCLIC ANTIDEPRESS 80303 CPT 5000599 CDM 301 RC Facility Outpatient 102 51 74.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 89 ORAL FLUID DRUG SCREEN 80303 CPT 5000628 CDM 301 RC Facility Outpatient 71 35.5 51.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 62 DRUG SCREEN SAP10 PT REQ 80303 CPT 5400031 CDM 301 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 DRUG SCREEN IN-HOUSE 80303 CPT 5400071 CDM 301 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 MARIJUANA - THC URINE 80303 CPT 5400096 CDM 301 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 DRUG SCREEN SAP 6 80307 CPT 5000030 CDM 301 RC Facility Outpatient 53 26.5 38.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 20.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 20 42 MEDICAL DRUG SCREEN (IN-HOUSE) 80307 CPT 5000070 CDM 301 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 56 114 DRUG SCR COMP TOX URINE&BLOOD 80307 CPT 5000364 CDM 301 RC Facility Outpatient 285 142.5 208.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 112.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 112 228 DRUG SCR SAP 6 + ALCH 80307 CPT 5000365 CDM 301 RC Facility Outpatient 58 29 42.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 22.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 22 46 DRUG SCR SERUM COURT ONLY 80307 CPT 5000366 CDM 301 RC Facility Outpatient 164 82 119.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 64.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 131.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 131.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64 131 DRUG SCREEN JUVENILE COURT 80307 CPT 5000369 CDM 301 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 20 40 DRUG SCREEN CNA STUDENT 80307 CPT 5000370 CDM 301 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 7 16 DRUG SCREEN COLLECTION FEE 80307 CPT 5000660 CDM 301 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 6 13 CANNABINOID SERUM 80307 CPT 5000842 CDM 301 RC Facility Outpatient 279 139.5 203.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 109.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 223.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 223.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 109 223 DRUG SCREEN PRESUMPTIVE 10 CLASS WHOLE 80307 CPT 5000910 CDM 306 RC Facility Outpatient 342.3 171.15 249.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 75.79 75.79 75.79 1 through 10 Percent of Total Billed Charges 134.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 115.22 115.22 115.22 1 through 10 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 64.22 62.27 64.22 1 through 10 Percent of Total Billed Charges 88 120.26 120.26 120.26 1 through 10 Percent of Total Billed Charges 273.84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91.62 51.7 143 1 through 10 Percent of Total Billed Charges 62.38 9.97 100 1 through 10 Percent of Total Billed Charges 273.84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 75.79 62.92 75.79 1 through 10 Percent of Total Billed Charges 53 62.92 62.92 75.79 16 Percent of Total Billed Charges 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 134 273 BLOOD ALCOHOL LEVEL 80320 CPT 5000013 CDM 301 RC Facility Outpatient 73 36.5 53.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.27 14.27 14.27 1 through 10 Percent of Total Billed Charges 64.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 121.55 121.55 121.55 1 through 10 Percent of Total Billed Charges 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 64 ALCOHOL BLOOD (ETOH) 80320 CPT 5000233 CDM 301 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.27 14.27 14.27 1 through 10 Percent of Total Billed Charges 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 121.55 121.55 121.55 1 through 10 Percent of Total Billed Charges 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 ACETAMINOPHEN 80329 CPT 5000228 CDM 301 RC Facility Outpatient 102 51 74.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 89 SALICYLATE BLOOD 80329 CPT 5000561 CDM 301 RC Facility Outpatient 107 53.5 78.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 94 CLOMIPRAMINE 80335 CPT 5000299 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 DOXEPIN LEVEL 80335 CPT 5000363 CDM 301 RC Facility Outpatient 62 31 45.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 54 TRAZODONE 80338 CPT 5000598 CDM 301 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 RISPERIDONE 80342 CPT 5000554 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 127 BARBITUATE LVL QUANT & TYPE 80345 CPT 5000267 CDM 301 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 PHENOBARBITAL 80345 CPT 5000521 CDM 301 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 BENZODIAZEPINE 80346 CPT 5000269 CDM 301 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 CLONAZEPAM (KLONOPIN) LEVEL 80346 CPT 5000698 CDM 301 RC Facility Outpatient 146 73 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 128 CLONZAEPAM 80346 CPT 5400017 CDM 301 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 BENZTROPINE 80375 CPT 5000270 CDM 301 RC Facility Outpatient 132 66 96.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 116 ACYCLOVIR 80375 CPT 5000863 CDM 301 RC Facility Outpatient 234 117 170.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 205 CORTISOL 3 SPECIMENS 80400 CPT 5000311 CDM 301 RC Facility Outpatient 154 77 112.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 135 URINALYSIS WITH MICRO 81001 CPT 5000052 CDM 307 RC Facility Outpatient 52 26 73 37.96 27.56 37.96 1 through 10 Percent of Total Billed Charges 53 27.56 27.56 27.56 14 Percent of Total Billed Charges 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.56 4.32 41.9 1 through 10 Percent of Total Billed Charges 53 21.56 21.56 21.56 13 Percent of Total Billed Charges 3.33 3.33 3.33 12 Percent of Total Billed Charges 88 43.73 26 43.73 1 through 10 Percent of Total Billed Charges 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52 0.77 52 1 through 10 Percent of Total Billed Charges 100 4.07 100 19 Percent of Total Billed Charges 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 27.56 22.88 44.2 1 through 10 Percent of Total Billed Charges 53 23.92 22.88 27.56 87 Percent of Total Billed Charges 53 21.56 21.56 22.29 13 Percent of Total Billed Charges 20 41 .UA WITH MICRO 81001 CPT 5000647 CDM 307 RC Facility Outpatient 52 26 73 37.96 27.56 37.96 1 through 10 Percent of Total Billed Charges 53 27.56 27.56 27.56 14 Percent of Total Billed Charges 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.56 4.32 41.9 1 through 10 Percent of Total Billed Charges 53 21.56 21.56 21.56 13 Percent of Total Billed Charges 3.33 3.33 3.33 12 Percent of Total Billed Charges 88 43.73 26 43.73 1 through 10 Percent of Total Billed Charges 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52 0.77 52 1 through 10 Percent of Total Billed Charges 100 4.07 100 19 Percent of Total Billed Charges 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 27.56 22.88 44.2 1 through 10 Percent of Total Billed Charges 53 23.92 22.88 27.56 87 Percent of Total Billed Charges 53 21.56 21.56 22.29 13 Percent of Total Billed Charges 20 41 MICROSCOPIC EXAM URINE 81001 CPT 5000907 CDM 306 RC Facility Outpatient 30 15 73 37.96 27.56 37.96 1 through 10 Percent of Total Billed Charges 53 27.56 27.56 27.56 14 Percent of Total Billed Charges 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.56 4.32 41.9 1 through 10 Percent of Total Billed Charges 53 21.56 21.56 21.56 13 Percent of Total Billed Charges 3.33 3.33 3.33 12 Percent of Total Billed Charges 88 43.73 26 43.73 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52 0.77 52 1 through 10 Percent of Total Billed Charges 100 4.07 100 19 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 27.56 22.88 44.2 1 through 10 Percent of Total Billed Charges 53 23.92 22.88 27.56 87 Percent of Total Billed Charges 53 21.56 21.56 22.29 13 Percent of Total Billed Charges 11 24 KETONES URINE 81002 CPT 5000467 CDM 307 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 URINE DIPSTICK ONLY 81003 CPT 5000607 CDM 307 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 .UA DIPSTICK ONLY 81003 CPT 5000646 CDM 307 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 URINE MICROSCOPIC ONLY 81015 CPT 5000611 CDM 307 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 URINE VOL MEAS -TIMED COLLECT 81050 CPT 5000077 CDM 307 RC Facility Outpatient 12 6 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 URINE VOL MEAS - TIMED COLLECT 81050 CPT 5400074 CDM 307 RC Facility Outpatient 6 3 4.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 5 HFE 81256 CPT 5000807 CDM 301 RC Facility Outpatient 495 247.5 361.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 396 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 396 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195 435 PRADER-WILLI AND ANGELMAN SYNDROME 81331 CPT 5000896 CDM 301 RC Facility Outpatient 483 241.5 352.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 386.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 386.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 367.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190 425 ACETONE SERUM 82009 CPT 5000045 CDM 301 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 45.41 45.41 45.41 1 through 10 Percent of Total Billed Charges 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 28.62 28.62 28.62 1 through 10 Percent of Total Billed Charges 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 43 ACETONE 82009 CPT 5400048 CDM 301 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 45.41 45.41 45.41 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 28.62 28.62 28.62 1 through 10 Percent of Total Billed Charges 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 ACTH 82024 CPT 5000230 CDM 301 RC Facility Outpatient 79 39.5 57.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 69 ALBUMIN 82040 CPT 5000232 CDM 301 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 ALBUMIN BODY FLUID 82042 CPT 5000670 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 MICROALBUMIN URINE 82043 CPT 5000495 CDM 301 RC Facility Outpatient 51 25.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 70.49 61.18 70.49 1 through 10 Percent of Total Billed Charges 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 MICROALBUMIN/CREATININE RATION URINE 82043 CPT 5000832 CDM 301 RC Facility Outpatient 133 66.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 70.49 61.18 70.49 1 through 10 Percent of Total Billed Charges 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 24 HR URINE MICROALBUMIN 82043 CPT 5000883 CDM 301 RC Facility Outpatient 81 40.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.93 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 70.49 61.18 70.49 1 through 10 Percent of Total Billed Charges 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 71 LEGAL BA - BLOOD ALCOHOL 82055 CPT 5000001 CDM 301 RC Facility Outpatient 107 53.5 78.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 94 ALCOHOL URINE 82055 CPT 5000014 CDM 301 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 ETHANOL BLOOD IN-HOUSE 82055 CPT 5400003 CDM 301 RC Facility Outpatient 18 9 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 BLOOD ALCOHOL LEVEL ABV AMB 82055 CPT 5400008 CDM 301 RC Facility Outpatient 18 9 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 ALCHOHOL URINE 82055 CPT 5400011 CDM 301 RC Facility Outpatient 18 9 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 ALDOLASE 82085 CPT 5000235 CDM 301 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 ALDOSTERONE - BLOOD 82088 CPT 5000236 CDM 301 RC Facility Outpatient 95 47.5 69.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 83 ALDOSTERONE - URINE 82088 CPT 5000237 CDM 301 RC Facility Outpatient 288 144 210.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113 253 ALDOSTERONE 82088 CPT 5000720 CDM 301 RC Facility Outpatient 138.78 69.39 101.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.55 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.13 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.47 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 ALPHA-1-ANTITRYPSINPHENOTYPE 82104 CPT 5000078 CDM 301 RC Facility Outpatient 170 85 124.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 149 ALPHA - 1 - ANTITRYPSINPHENOTYPE 82104 CPT 5400075 CDM 301 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 ALPHA FETOPROTEIN 82105 CPT 5000239 CDM 301 RC Facility Outpatient 132 66 96.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 112.2 112.2 112.2 1 through 10 Percent of Total Billed Charges 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.74 54.74 54.74 1 through 10 Percent of Total Billed Charges 52 116 ALUMINUM LEVEL 82108 CPT 5000882 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 127 AMINO ACID SCREEN 82128 CPT 5000242 CDM 301 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 HOMOCYSTEINE 82131 CPT 5000438 CDM 301 RC Facility Outpatient 206 103 150.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 181 HOMOCYSTEINE PLASMA 82131 CPT 5000523 CDM 301 RC Facility Outpatient 208 104 151.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 183 CYSTEINE 82131 CPT 5000852 CDM 301 RC Facility Outpatient 202 101 147.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 177 AMINOLEVULINIC ACID 82135 CPT 5000243 CDM 301 RC Facility Outpatient 105 52.5 76.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 92 AMMONIA 82140 CPT 5000245 CDM 301 RC Facility Outpatient 162 81 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 85.86 71.28 85.86 1 through 10 Percent of Total Billed Charges 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 AMPHETAMINE QUANT 82145 CPT 5000247 CDM 301 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 AMYLASE BODY FLUID 82150 CPT 5000248 CDM 301 RC Facility Outpatient 55 27.5 73 68.62 68.62 68.62 1 through 10 Percent of Total Billed Charges 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.33 38.99 45.33 1 through 10 Percent of Total Billed Charges 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 94 94 94 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.82 41.36 49.82 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 38.99 1 through 10 Percent of Total Billed Charges 21 44 AMYLASE SERUM 82150 CPT 5000249 CDM 301 RC Facility Outpatient 94 47 73 68.62 68.62 68.62 1 through 10 Percent of Total Billed Charges 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.33 38.99 45.33 1 through 10 Percent of Total Billed Charges 38.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 94 94 94 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.82 41.36 49.82 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 38.99 1 through 10 Percent of Total Billed Charges 37 75 AMYLASE TIMED URINE 82150 CPT 5000250 CDM 301 RC Facility Outpatient 56 28 73 68.62 68.62 68.62 1 through 10 Percent of Total Billed Charges 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.33 38.99 45.33 1 through 10 Percent of Total Billed Charges 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 94 94 94 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.82 41.36 49.82 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 38.99 1 through 10 Percent of Total Billed Charges 22 44 AMYLASE URINE RANDOM 82150 CPT 5000251 CDM 301 RC Facility Outpatient 25 12.5 73 68.62 68.62 68.62 1 through 10 Percent of Total Billed Charges 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.33 38.99 45.33 1 through 10 Percent of Total Billed Charges 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 94 94 94 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.82 41.36 49.82 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 38.99 1 through 10 Percent of Total Billed Charges 9 20 TOTAL AMYLASE 82150 CPT 5400115 CDM 301 RC Facility Outpatient 11 5.5 73 68.62 68.62 68.62 1 through 10 Percent of Total Billed Charges 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.33 38.99 45.33 1 through 10 Percent of Total Billed Charges 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 94 94 94 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.82 41.36 49.82 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 38.99 1 through 10 Percent of Total Billed Charges 4 8 ANABOLIC STEROIDS 82157 CPT 5000111 CDM 301 RC Facility Outpatient 345 172.5 251.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 303.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 303 ANDROSTENEDIONE 82157 CPT 5000843 CDM 301 RC Facility Outpatient 195 97.5 142.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 ANABOLIC STEROIDS 82157 CPT 5400111 CDM 301 RC Facility Outpatient 49 24.5 35.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 43 ANGIOTENSIN CONV ENZ 82164 CPT 5000253 CDM 301 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 ARSENIC BLOOD 82175 CPT 5000258 CDM 301 RC Facility Outpatient 79 39.5 57.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 69 ARSENIC UR QT 24HR 82175 CPT 5000259 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HEAVY METALS PROFILE II WHOLE BLOOD 82175 CPT 5000909 CDM 306 RC Facility Outpatient 555.45 277.72 405.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 488.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 223.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 422.14 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.51 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218 488 VITAMIN C 82180 CPT 5000806 CDM 301 RC Facility Outpatient 94 47 68.62 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 82 B2 MICROGLOBINLIN SERUM 82232 CPT 5000849 CDM 301 RC Facility Outpatient 126 63 91.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 BETA MICROGLOBULIN 82232 CPT 5000877 CDM 301 RC Facility Outpatient 126 63 91.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 BILIRUBIN SERUM TOTAL 82247 CPT 5000037 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 BILIRUBIN BODY FLUID 82247 CPT 5000271 CDM 301 RC Facility Outpatient 40 20 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 BILIRUBIN SERUM TOTAL 82247 CPT 5400042 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BILIRUBIN DIRECT 82248 CPT 5000036 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 BILIRUBIN FRACT 82248 CPT 5000272 CDM 301 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 DIRECT BILIRUBIN 82248 CPT 5400040 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 "OCCULT BLOOD, STOOL" 82270 CPT 5000511 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 22.26 22.26 22.26 1 through 10 Percent of Total Billed Charges 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 17.42 17.42 17.42 1 through 10 Percent of Total Billed Charges 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.48 18.48 22.26 1 through 10 Percent of Total Billed Charges 53 17.42 17.42 17.42 1 through 10 Percent of Total Billed Charges 16 36 "OCCULT BLOOD, GASTRIC FLUID" 82271 CPT 5000664 CDM 301 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 VITAMIN D-25 HYDROXY 82306 CPT 5000620 CDM 301 RC Facility Outpatient 253 126.5 73 184.69 184.69 184.69 1 through 10 Percent of Total Billed Charges 53 134.09 134.09 134.09 1 through 10 Percent of Total Billed Charges 99.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 104.92 104.92 104.92 1 through 10 Percent of Total Billed Charges 31.08 31.08 31.08 1 through 10 Percent of Total Billed Charges 88 212.77 212.77 212.77 1 through 10 Percent of Total Billed Charges 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 253 26.92 253 12 Percent of Total Billed Charges 37.96 37.96 37.96 1 through 10 Percent of Total Billed Charges 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 134.09 116.38 134.09 1 through 10 Percent of Total Billed Charges 53 134.09 111.32 134.09 40 Percent of Total Billed Charges 53 104.92 104.92 108.44 1 through 10 Percent of Total Billed Charges 99 202 CALCITONIN SERUM 82308 CPT 5000850 CDM 301 RC Facility Outpatient 211 105.5 154.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 185 CALCIUM 82310 CPT 5000281 CDM 301 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 CALCIUM BODY FLUID 82310 CPT 5000669 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 CALCIUM IONIZED 82330 CPT 5000282 CDM 301 RC Facility Outpatient 48 24 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 48 48 48 1 through 10 Percent of Total Billed Charges 19.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 42 PARATHYROID PANEL 82330 CPT 5400066 CDM 301 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 48 48 48 1 through 10 Percent of Total Billed Charges 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 CALCIUM 24HR URINE 82340 CPT 5000047 CDM 301 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 URINE CALCIUM 24HR 82340 CPT 5400050 CDM 301 RC Facility Outpatient 11 5.5 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 STONE ANALYSIS 82360 CPT 5000577 CDM 301 RC Facility Outpatient 120 60 87.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 CALCULUS ANALYSIS 82370 CPT 5000283 CDM 301 RC Facility Outpatient 292 146 213.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 256 CO2 82374 CPT 5000634 CDM 301 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 CARBON DIOXIDE 82374 CPT 5400119 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARBOXYHEMOGLOBIN 82375 CPT 5000285 CDM 301 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 CO-OX CARBOXYHEMOGLOBIN 82375 CPT 5400118 CDM 301 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 CARBOXY HEMOGLOBIN 82375 CPT 9600005 CDM 301 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 CEA 82378 CPT 5000288 CDM 301 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 CAROTENE 82380 CPT 5000286 CDM 301 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 CATECHOLAMINES URINE 82382 CPT 5000089 CDM 301 RC Facility Outpatient 121 60.5 88.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 106 URINE CATECHOLINES 82382 CPT 5400086 CDM 301 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 CATECHOLAMINES PLASMA 82384 CPT 5000146 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 CERULOPLASMIN 82390 CPT 5000290 CDM 301 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 PTH RELATED PROTEIN 82397 CPT 5000811 CDM 301 RC Facility Outpatient 188 94 137.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 165 CHLORIDE SERUM 82435 CPT 5000040 CDM 301 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 CHLORIDE SERUM 82435 CPT 5400044 CDM 301 RC Facility Outpatient 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CHLORIDE URINE 82436 CPT 5000123 CDM 301 RC Facility Outpatient 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 URINE CL 82436 CPT 5400056 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CSF CHLORIDE 82438 CPT 5000080 CDM 301 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 CHLORIDE BODY FLUID 82438 CPT 5000668 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 CHLORIDE STOOL 82438 CPT 5000737 CDM 301 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 CSF CHLORINE 82438 CPT 5400077 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CHOLESTEROL 82465 CPT 5000293 CDM 301 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 PSEUDOCHOLINESTERASE 82480 CPT 5000542 CDM 301 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 CHROMIUM SERUM TESTING 82495 CPT 5000753 CDM 301 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 CHROMIUM 82495 CPT 5000801 CDM 300 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 CITRIC ACID 24HR URINE 82507 CPT 5000024 CDM 301 RC Facility Outpatient 285 142.5 208.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 250 URINE CITRIC ACID 24HR 82507 CPT 5400024 CDM 301 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 COCAINE METABOLITES 82520 CPT 5000304 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 COLLAGEN CROSS LINKS ANY METHOD 82523 CPT 5000144 CDM 301 RC Facility Outpatient 125 62.5 91.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 N TILOPEPTIDE 82523 CPT 5000853 CDM 301 RC Facility Outpatient 282 141 205.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.46 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 248.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 225.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 225.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111 248 COPPER LEVEL 82525 CPT 5000054 CDM 301 RC Facility Outpatient 252 126 183.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99 221 CORTISOL FREE (U) 82530 CPT 5000312 CDM 301 RC Facility Outpatient 144 72 105.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 126 URINE CORTISOL 24 HRS 82530 CPT 5000755 CDM 301 RC Facility Outpatient 183 91.5 133.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 CORTISOL BLOOD 82533 CPT 5000086 CDM 301 RC Facility Outpatient 136 68 99.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.4 56.4 56.4 1 through 10 Percent of Total Billed Charges 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 59.84 59.84 59.84 1 through 10 Percent of Total Billed Charges 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119 CORTISOL SERIAL SAMPLE 82533 CPT 5400070 CDM 301 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.4 56.4 56.4 1 through 10 Percent of Total Billed Charges 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 59.84 59.84 59.84 1 through 10 Percent of Total Billed Charges 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 CORTISOL - BLOOD 82533 CPT 5400084 CDM 301 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.4 56.4 56.4 1 through 10 Percent of Total Billed Charges 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 59.84 59.84 59.84 1 through 10 Percent of Total Billed Charges 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 PORPHYRINS PLASMA 82542 CPT 5000019 CDM 301 RC Facility Outpatient 155 77.5 113.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 136 ZANTAC LEVEL 82542 CPT 5000626 CDM 301 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 "LEVETIRACETAM, S (KEPPRA)" 82542 CPT 5000661 CDM 301 RC Facility Outpatient 152 76 110.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 133 ZONISAMIDE 82542 CPT 5000672 CDM 301 RC Facility Outpatient 148 74 108.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 130 LAMICTAL 82542 CPT 5000674 CDM 301 RC Facility Outpatient 170 85 124.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 149 OXY QUANT-SERUM 82542 CPT 5000714 CDM 301 RC Facility Outpatient 211 105.5 154.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 97.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 185 "SULFONYLUREA SCREEN, QT" 82542 CPT 5000754 CDM 301 RC Facility Outpatient 209 104.5 152.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82 183 OMEGA 3 AND 6 82542 CPT 5000879 CDM 301 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.88 66.88 66.88 1 through 10 Percent of Total Billed Charges 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 CPK 82550 CPT 5000316 CDM 301 RC Facility Outpatient 56 28 73 40.88 29.68 40.88 1 through 10 Percent of Total Billed Charges 53 29.68 29.68 29.68 16 Percent of Total Billed Charges 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.12 23.22 46.45 1 through 10 Percent of Total Billed Charges 53 23.22 23.22 27 1 through 10 Percent of Total Billed Charges 6.35 6.35 6.35 1 through 10 Percent of Total Billed Charges 88 47.1 47.1 47.1 1 through 10 Percent of Total Billed Charges 80 56 56 56 1 through 10 Percent of Total Billed Charges 53 56 56 56 15 Percent of Total Billed Charges 100 10.86 100 1 through 10 Percent of Total Billed Charges 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 29.68 24.64 47.6 1 through 10 Percent of Total Billed Charges 53 25.76 24.64 29.68 54 Percent of Total Billed Charges 53 23.22 23.22 24 1 through 10 Percent of Total Billed Charges 22 44 CPK ISOENZYMES 82552 CPT 5000317 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 CK-MB 82553 CPT 5000318 CDM 301 RC Facility Outpatient 66 33 73 126.29 91.69 126.29 1 through 10 Percent of Total Billed Charges 53 91.69 34.98 91.69 16 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 71.74 71.74 139.39 1 through 10 Percent of Total Billed Charges 53 71.74 27.37 71.74 1 through 10 Percent of Total Billed Charges 12.13 12.13 12.13 1 through 10 Percent of Total Billed Charges 88 145.49 55.51 145.49 1 through 10 Percent of Total Billed Charges 80 173 173 173 1 through 10 Percent of Total Billed Charges 53 66 58.08 173 13 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76.12 34.98 147.05 1 through 10 Percent of Total Billed Charges 53 76.12 34.98 79.58 48 Percent of Total Billed Charges 53 71.74 27.37 74.15 1 through 10 Percent of Total Billed Charges 26 52 CREATININE SERUM (CR-S) 82565 CPT 5000322 CDM 301 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.49 19.49 19.49 1 through 10 Percent of Total Billed Charges 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.16 19.16 19.16 1 through 10 Percent of Total Billed Charges 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 GLOMERULAR FILTRATION RATE (GFR) 82565 CPT 5000676 CDM 302 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.49 19.49 19.49 1 through 10 Percent of Total Billed Charges 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.16 19.16 19.16 1 through 10 Percent of Total Billed Charges 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 CREATININE TEST 82565 CPT 5003322 CDM 301 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.49 19.49 19.49 1 through 10 Percent of Total Billed Charges 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.16 19.16 19.16 1 through 10 Percent of Total Billed Charges 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 CREATININE URINE RANDOM 82570 CPT 5000321 CDM 301 RC Facility Outpatient 74 37 73 94.17 94.17 94.17 1 through 10 Percent of Total Billed Charges 53 56.71 39.22 68.37 1 through 10 Percent of Total Billed Charges 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.37 30.69 44.37 1 through 10 Percent of Total Billed Charges 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 10.2 129 1 through 10 Percent of Total Billed Charges 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68.37 59.34 68.37 1 through 10 Percent of Total Billed Charges 53 47.08 32.56 68.37 35 Percent of Total Billed Charges 53 31.71 30.69 53.5 1 through 10 Percent of Total Billed Charges 29 65 CREATININE URINE TIMED 82570 CPT 5000651 CDM 307 RC Facility Outpatient 74 37 73 94.17 94.17 94.17 1 through 10 Percent of Total Billed Charges 53 56.71 39.22 68.37 1 through 10 Percent of Total Billed Charges 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.37 30.69 44.37 1 through 10 Percent of Total Billed Charges 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 10.2 129 1 through 10 Percent of Total Billed Charges 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68.37 59.34 68.37 1 through 10 Percent of Total Billed Charges 53 47.08 32.56 68.37 35 Percent of Total Billed Charges 53 31.71 30.69 53.5 1 through 10 Percent of Total Billed Charges 29 65 CREATININE BODY FLUID 82570 CPT 5000665 CDM 301 RC Facility Outpatient 42 21 73 94.17 94.17 94.17 1 through 10 Percent of Total Billed Charges 53 56.71 39.22 68.37 1 through 10 Percent of Total Billed Charges 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.37 30.69 44.37 1 through 10 Percent of Total Billed Charges 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 10.2 129 1 through 10 Percent of Total Billed Charges 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68.37 59.34 68.37 1 through 10 Percent of Total Billed Charges 53 47.08 32.56 68.37 35 Percent of Total Billed Charges 53 31.71 30.69 53.5 1 through 10 Percent of Total Billed Charges 16 36 PROTEIN CREATINE RATIO - URINE RANDOM 82570 CPT 5000834 CDM 301 RC Facility Outpatient 107 53.5 73 94.17 94.17 94.17 1 through 10 Percent of Total Billed Charges 53 56.71 39.22 68.37 1 through 10 Percent of Total Billed Charges 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.37 30.69 44.37 1 through 10 Percent of Total Billed Charges 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 10.2 129 1 through 10 Percent of Total Billed Charges 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68.37 59.34 68.37 1 through 10 Percent of Total Billed Charges 53 47.08 32.56 68.37 35 Percent of Total Billed Charges 53 31.71 30.69 53.5 1 through 10 Percent of Total Billed Charges 42 94 ALBUMIN CREATINE RATIO URINE 82570 CPT 5000878 CDM 301 RC Facility Outpatient 129 64.5 73 94.17 94.17 94.17 1 through 10 Percent of Total Billed Charges 53 56.71 39.22 68.37 1 through 10 Percent of Total Billed Charges 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.37 30.69 44.37 1 through 10 Percent of Total Billed Charges 53.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 10.2 129 1 through 10 Percent of Total Billed Charges 51.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68.37 59.34 68.37 1 through 10 Percent of Total Billed Charges 53 47.08 32.56 68.37 35 Percent of Total Billed Charges 53 31.71 30.69 53.5 1 through 10 Percent of Total Billed Charges 50 113 CREATININE CLEARANCE 82575 CPT 5000320 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.85 76.85 76.85 1 through 10 Percent of Total Billed Charges 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 145 145 145 1 through 10 Percent of Total Billed Charges 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 66.7 63.8 76.85 1 through 10 Percent of Total Billed Charges 53 60.14 60.14 60.14 1 through 10 Percent of Total Billed Charges 57 127 CRYOGLOBULINS 82595 CPT 5000323 CDM 301 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 VITAMIN B12 82607 CPT 5000618 CDM 301 RC Facility Outpatient 101 50.5 73 73.73 73.73 73.73 1 through 10 Percent of Total Billed Charges 53 53.53 53.53 53.53 1 through 10 Percent of Total Billed Charges 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 41.89 41.89 41.89 1 through 10 Percent of Total Billed Charges 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 101 95.68 101 1 through 10 Percent of Total Billed Charges 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53.53 44.44 53.53 1 through 10 Percent of Total Billed Charges 53 41.89 41.89 41.89 1 through 10 Percent of Total Billed Charges 39 88 DHEA 82626 CPT 5000358 CDM 301 RC Facility Outpatient 226 113 164.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 198 DHEA SULFATE 82627 CPT 5000357 CDM 301 RC Facility Outpatient 232 116 169.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 204 DEOXYCORTICOSTERONE 82633 CPT 5000355 CDM 301 RC Facility Outpatient 255 127.5 186.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 224 DEOXYCORTISOL 11 82634 CPT 5000025 CDM 301 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 DEOXYCORTISOL 11 82634 CPT 5000356 CDM 301 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 DEOXYCORTISOL 11 82634 CPT 5400025 CDM 301 RC Facility Outpatient 49 24.5 35.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 43 VITAMIN D 125 82652 CPT 5000065 CDM 301 RC Facility Outpatient 158 79 115.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 VITAMIN D 1 25 82652 CPT 5000067 CDM 301 RC Facility Outpatient 158 79 115.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 "VITAMIN D 1,25 DEHYDROXY" 82652 CPT 5000652 CDM 301 RC Facility Outpatient 253 126.5 184.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99 222 VITAMIN D 1.25 82652 CPT 5400067 CDM 301 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 ERYTHROPOIETIN LEVEL 82668 CPT 5000382 CDM 301 RC Facility Outpatient 176 88 128.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 154 ESTRADIOL BLOOD 82670 CPT 5000094 CDM 301 RC Facility Outpatient 80 40 73 58.4 58.4 58.4 1 through 10 Percent of Total Billed Charges 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.12 38.12 38.12 1 through 10 Percent of Total Billed Charges 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68 35.2 68 1 through 10 Percent of Total Billed Charges 53 42.4 42.4 42.4 1 through 10 Percent of Total Billed Charges 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 ESTRADIOL - BLOOD 82670 CPT 5400092 CDM 301 RC Facility Outpatient 47 23.5 73 58.4 58.4 58.4 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.12 38.12 38.12 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 68 35.2 68 1 through 10 Percent of Total Billed Charges 53 42.4 42.4 42.4 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 ESTROGEN FRAC BLOOD 82671 CPT 5000384 CDM 301 RC Facility Outpatient 285 142.5 208.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 250 ESTROGEN FRAC URINE 82671 CPT 5000385 CDM 301 RC Facility Outpatient 270 135 197.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 237 ESTROGEN SERUM TOTAL 82672 CPT 5000383 CDM 301 RC Facility Outpatient 159 79.5 116.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 ESTRONE SERUM 82679 CPT 5000836 CDM 301 RC Facility Outpatient 202 101 147.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 177 ETHELENE GLYCOL 82693 CPT 5000386 CDM 301 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 FECAL FAT SCREEN 82705 CPT 5000389 CDM 301 RC Facility Outpatient 68 34 49.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 59 SUNDAN BLUE III 82705 CPT 5400113 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FECAL FAT QUANT 82710 CPT 5000388 CDM 302 RC Facility Outpatient 131 65.5 95.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 115 FERRITIN SERUM 82728 CPT 5000392 CDM 301 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 48.76 48.76 48.76 1 through 10 Percent of Total Billed Charges 17.13 17.13 17.13 1 through 10 Percent of Total Billed Charges 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.15 38.15 38.15 1 through 10 Percent of Total Billed Charges 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92 92 92 1 through 10 Percent of Total Billed Charges 17.47 17.47 17.47 1 through 10 Percent of Total Billed Charges 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 48.76 42.32 78.2 1 through 10 Percent of Total Billed Charges 53 40.48 40.48 48.76 30 Percent of Total Billed Charges 53 38.15 38.15 39.43 1 through 10 Percent of Total Billed Charges 38 80 FOLIC ACID SERUM 82746 CPT 5000396 CDM 301 RC Facility Outpatient 87 43.5 63.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 40.02 40.02 40.02 1 through 10 Percent of Total Billed Charges 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 76 FOLATE RBC 82747 CPT 5000395 CDM 301 RC Facility Outpatient 71 35.5 51.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 62 FRUCTOSE SEMEN QL 82757 CPT 5000398 CDM 301 RC Facility Outpatient 91 45.5 66.43 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 80 IGA & IGG 82784 CPT 5000084 CDM 301 RC Facility Outpatient 206 103 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 81.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 181 IGA 82784 CPT 5000455 CDM 301 RC Facility Outpatient 72 36 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 IGG 82784 CPT 5000457 CDM 301 RC Facility Outpatient 72 36 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 IGG CSF 82784 CPT 5000458 CDM 301 RC Facility Outpatient 39 19.5 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 IGM 82784 CPT 5000460 CDM 301 RC Facility Outpatient 72 36 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 IG PANEL 82784 CPT 5000915 CDM 302 RC Facility Outpatient 195.3 97.65 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 76.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.86 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.43 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 CSF IGG 82784 CPT 5400062 CDM 301 RC Facility Outpatient 16 8 73 213.89 213.89 213.89 1 through 10 Percent of Total Billed Charges 53 38.16 38.16 38.16 1 through 10 Percent of Total Billed Charges 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 IGE 82785 CPT 5000456 CDM 301 RC Facility Outpatient 107 53.5 78.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 94 TOTAL IMMUNOGLOBIN 82785 CPT 5000594 CDM 301 RC Facility Outpatient 82 41 59.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.46 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 72 ZONE 8 ALLERGENS 82785 CPT 5000917 CDM 300 RC Facility Outpatient 97.8 48.9 71.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.99 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.99 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.06 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.99 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.33 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.99 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.99 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 IGG SYNTHESIS/INDEX 82787 CPT 5000459 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 ARTERIAL BLOOD GAS 82803 CPT 9600001 CDM 301 RC Facility Outpatient 251 125.5 183.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 133.03 133.03 133.03 1 through 10 Percent of Total Billed Charges 98.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 110.44 110.44 110.44 1 through 10 Percent of Total Billed Charges 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 GASTRIN LEVEL 82941 CPT 5000403 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 127 GLUCOSE BODY FLUID 82945 CPT 5000015 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 CSF GLUCOSE 82945 CPT 5000082 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 GLUCOSE 82947 CPT 5000409 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 GLUCOSE TOLERANCE 1HR 82947 CPT 5099017 CDM 300 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 GLUCOSE PLEURAL FLUID 82947 CPT 5400012 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 CSF GLUCOSE 82947 CPT 5400079 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 GLUCOSE - ACCUCHECK 82948 CPT 5000407 CDM 309 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 5.3 5.3 5.3 1 through 10 Percent of Total Billed Charges 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 GLUCOSE 2 HR PP 82950 CPT 5000408 CDM 301 RC Facility Outpatient 74 37 54.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 65 GLUCOSE TOLERANCE 2HR 82951 CPT 5000031 CDM 301 RC Facility Outpatient 98 49 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 GLUCOSE TOLERANCE 3HR 82951 CPT 5000033 CDM 301 RC Facility Outpatient 128 64 93.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 112 GLUCOSE TOLERANCE 2HR 82951 CPT 5400033 CDM 301 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 GLUCOSE TOLERANCE 3 HR 82951 CPT 5400036 CDM 301 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 GLUCOSE TOLERANCE ADDITIONAL 82952 CPT 5000032 CDM 301 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 .GLUCOSE TOLERANCE ADDITION 82952 CPT 5400034 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 G6PD 82955 CPT 5000402 CDM 301 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 GGT 82977 CPT 5000633 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 40.28 40.28 40.28 1 through 10 Percent of Total Billed Charges 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 FRUCTOSAMINE 82985 CPT 5000126 CDM 301 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 FSH BLOOD 83001 CPT 5000399 CDM 301 RC Facility Outpatient 114 57 83.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 96.9 50.16 96.9 1 through 10 Percent of Total Billed Charges 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 100 LUTENIZING HORMONE BLOOD 83002 CPT 5000485 CDM 301 RC Facility Outpatient 131 65.5 95.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 111.35 57.64 111.35 1 through 10 Percent of Total Billed Charges 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 115 HUMAN GROWTH HORMONE 83003 CPT 5000138 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 HAPTOGLOBIN 83010 CPT 5000415 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HEAVY METAL SCREEN 83015 CPT 5000422 CDM 301 RC Facility Outpatient 334 167 243.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 293.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131 293 COBALT PLASMA TESTING 83018 CPT 5000752 CDM 301 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 HEAVY METAL EACH 83018 CPT 5000800 CDM 300 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 HGB ELECTROPHORESIS 83020 CPT 5000432 CDM 301 RC Facility Outpatient 144 72 105.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 126 FETAL MATERNAL HEMORRHAGE SCRREN 83033 CPT 5000149 CDM 301 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 FETAL MATERNAL HEMORRHAGE SCREEN 83033 CPT 5000151 CDM 301 RC Facility Outpatient 98 49 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 HGB A1C 83036 CPT 5000431 CDM 301 RC Facility Outpatient 91 45.5 73 66.43 66.43 66.43 19 Percent of Total Billed Charges 53 48.23 48.23 48.23 17 Percent of Total Billed Charges 35.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 13.24 13.24 73.32 1 through 10 Percent of Total Billed Charges 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 76.53 76.53 76.53 1 through 10 Percent of Total Billed Charges 80 91 19.76 91 1 through 10 Percent of Total Billed Charges 53 91 47.32 91 40 Percent of Total Billed Charges 12.44 12.44 12.44 1 through 10 Percent of Total Billed Charges 72.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 48.23 40.04 77.35 14 Percent of Total Billed Charges 53 41.86 40.04 48.23 65 Percent of Total Billed Charges 53 37.74 37.74 39 13 Percent of Total Billed Charges 35 72 FREE HEMOGLOBIN 83051 CPT 5000068 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 FREE HEMOGLOBIN 83051 CPT 5400069 CDM 301 RC Facility Outpatient 13 6.5 9.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 11 HYDROXYCORTICOSTER17 24H URINE 83491 CPT 5000011 CDM 301 RC Facility Outpatient 62 31 45.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 54 HYDROXYCORTICOSTER17 24HOUR URINE 83491 CPT 5400005 CDM 301 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 HIAA-5 83497 CPT 5000433 CDM 301 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 HYDROXYPROGESTER - 17 D 83498 CPT 5000097 CDM 301 RC Facility Outpatient 77 38.5 56.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 67 17 HYDROPROGESTERONE 83498 CPT 5000839 CDM 301 RC Facility Outpatient 152 76 110.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 133 HYDROXYPRO ASSAY SERUM 83498 CPT 5400063 CDM 301 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 HYDROXYPROGESTER - 17 83498 CPT 5400095 CDM 301 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 HYDROXYPROLINE FREE 83500 CPT 5000440 CDM 301 RC Facility Outpatient 114 57 83.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 100 HYDROXYPROLINE TOTAL 83505 CPT 5000441 CDM 301 RC Facility Outpatient 114 57 83.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 100 Immunoassay analyte other than infectiou 83516 CPT 5000802 CDM 300 RC Facility Outpatient 49 24.5 35.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 43 NEUROPATHY PANEL II 83516 CPT 5000841 CDM 301 RC Facility Outpatient 138 69 100.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 121 SMOOTH MUSCLE ANTIBODY 83516 CPT 5000851 CDM 301 RC Facility Outpatient 50 25 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 TTG IGG 83516 CPT 5000871 CDM 301 RC Facility Outpatient 119 59.5 86.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 104 TTG IGA 83516 CPT 5000872 CDM 301 RC Facility Outpatient 132 66 96.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 116 MUSCLE SPECIFIC KIANASE ANTIBODY 83516 CPT 5000889 CDM 301 RC Facility Outpatient 119 59.5 86.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 104 GANGLIOSIDE ANTIBODY PANEL 83516 CPT 5000908 CDM 306 RC Facility Outpatient 864 432 630.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 457.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 357.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 760.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 691.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 691.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 656.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 397.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 340 760 ANTIGLIADIN AB IGG 83516 CPT 5400027 CDM 301 RC Facility Outpatient 123 61.5 89.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 LEGIONELLA URINE AG 83519 CPT 5000477 CDM 301 RC Facility Outpatient 79 39.5 57.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 69 GAD 83519 CPT 5000739 CDM 301 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 PANCREATIC PEPTIDE LEVEL 83519 CPT 5000741 CDM 301 RC Facility Outpatient 266 133 194.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 122.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 234 MYASTHENIA GRAVIS EVAL PROFILE 83519 CPT 5000835 CDM 301 RC Facility Outpatient 393 196.5 286.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 180.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 314.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 314.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 298.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154 345 GHRELIN 83519 CPT 5000874 CDM 301 RC Facility Outpatient 508 254 370.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 233.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 447.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 406.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 406.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 386.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200 447 ACHR MODULATING ANTIBODIES 83519 CPT 5000887 CDM 301 RC Facility Outpatient 312 156 227.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122 274 ACETYCHOLINE RECEPTOR BLOCKING ANTIBODY 83519 CPT 5000888 CDM 301 RC Facility Outpatient 278 139 202.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109 244 ACHR BINDING ANTIBODIES 83519 CPT 5000890 CDM 301 RC Facility Outpatient 312 156 227.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59.3 59.3 59.3 1 through 10 Percent of Total Billed Charges 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122 274 "ANTIGLOMERULAR BM AB, QN" 83520 CPT 5000663 CDM 301 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 IGF-BP3 83520 CPT 5000690 CDM 301 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 TUMOR NECROSIS FACTOR ALPHA (TNF) 83520 CPT 5000847 CDM 301 RC Facility Outpatient 268 134 195.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 235.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 123.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105 235 THYROTROPIN RECEPTOR ANTIBODY 83520 CPT 5000869 CDM 301 RC Facility Outpatient 198 99 144.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 91.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 174 LEPTIN 83520 CPT 5000875 CDM 301 RC Facility Outpatient 119 59.5 86.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 104 ANTIGLIADIN AB IGA 83520 CPT 5400081 CDM 301 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 TRYPTASE 83520 CPT 5400120 CDM 301 RC Facility Outpatient 57 28.5 41.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 73.14 73.14 73.14 1 through 10 Percent of Total Billed Charges 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 INSULIN LEVEL 83525 CPT 5000164 CDM 301 RC Facility Outpatient 57 28.5 73 41.61 41.61 41.61 1 through 10 Percent of Total Billed Charges 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 IRON 83540 CPT 5000466 CDM 301 RC Facility Outpatient 64 32 73 46.72 46.72 46.72 1 through 10 Percent of Total Billed Charges 53 33.92 33.92 67.84 1 through 10 Percent of Total Billed Charges 8.15 8.15 8.15 1 through 10 Percent of Total Billed Charges 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 26.54 26.54 26.54 1 through 10 Percent of Total Billed Charges 6.79 6.79 6.79 1 through 10 Percent of Total Billed Charges 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 64 64 64 1 through 10 Percent of Total Billed Charges 8.31 8.31 8.31 1 through 10 Percent of Total Billed Charges 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.4 29.44 67.84 1 through 10 Percent of Total Billed Charges 53 28.16 28.16 56.32 37 Percent of Total Billed Charges 53 26.54 26.54 27.43 1 through 10 Percent of Total Billed Charges 33 56 TIBC 83550 CPT 5000590 CDM 301 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.99 43.99 43.99 1 through 10 Percent of Total Billed Charges 10.99 10.99 10.99 1 through 10 Percent of Total Billed Charges 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.18 9.18 9.18 1 through 10 Percent of Total Billed Charges 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 83 40.7 83 1 through 10 Percent of Total Billed Charges 11.21 11.21 11.21 1 through 10 Percent of Total Billed Charges 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 43.99 38.18 70.55 1 through 10 Percent of Total Billed Charges 53 38.18 36.52 43.99 28 Percent of Total Billed Charges 53 34.42 34.42 35.57 1 through 10 Percent of Total Billed Charges 38 73 URINE KETOSTEROID 17 24HR 83586 CPT 5000091 CDM 301 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 URINE KETOSTEROID 17 24 HR 83586 CPT 5400088 CDM 301 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 L8 HYDROXY DOC 83593 CPT 5000018 CDM 301 RC Facility Outpatient 309 154.5 225.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 271.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 247.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 247.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121 271 LB HYDROXY DOC 83593 CPT 5400016 CDM 301 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 LACTATE 83605 CPT 5000469 CDM 301 RC Facility Outpatient 82 41 59.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.46 43.46 43.46 1 through 10 Percent of Total Billed Charges 32.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34 34 34 1 through 10 Percent of Total Billed Charges 53 34 34 79.08 1 through 10 Percent of Total Billed Charges 33.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82 82 82 1 through 10 Percent of Total Billed Charges 32.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 37.72 36.08 72.16 15 Percent of Total Billed Charges 53 35.15 35.15 35.15 1 through 10 Percent of Total Billed Charges 32 72 LDH BODY FLUID 83615 CPT 5000008 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 LDH 83615 CPT 5000631 CDM 301 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 LACTATE CSF 83615 CPT 5000862 CDM 301 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 LACTATE DEHYDROGENASE 83615 CPT 5000911 CDM 306 RC Facility Outpatient 180 90 131.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70 158 LDM/BODY FLUID 83615 CPT 5400001 CDM 301 RC Facility Outpatient 11 5.5 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 LDH BODY FLUID 83615 CPT 5400041 CDM 301 RC Facility Outpatient 11 5.5 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 LDH ISOENZYMES 83625 CPT 5000470 CDM 301 RC Facility Outpatient 156 78 113.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 137 LEAD BLOOD 83655 CPT 5000471 CDM 301 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 LEUCINE AMINOPEPTIDASE 83670 CPT 5000478 CDM 301 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 LIPASE SERUM 83690 CPT 5000043 CDM 301 RC Facility Outpatient 93 46.5 73 67.89 67.89 67.89 1 through 10 Percent of Total Billed Charges 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.85 38.56 44.85 1 through 10 Percent of Total Billed Charges 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 78.21 78.21 78.21 1 through 10 Percent of Total Billed Charges 80 93 93 93 1 through 10 Percent of Total Billed Charges 53 93 93 93 1 through 10 Percent of Total Billed Charges 8.83 8.83 8.83 1 through 10 Percent of Total Billed Charges 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.78 40.92 49.29 1 through 10 Percent of Total Billed Charges 53 38.56 38.56 38.56 1 through 10 Percent of Total Billed Charges 36 74 LIPASE FLUID 83690 CPT 5400010 CDM 301 RC Facility Outpatient 12 6 73 67.89 67.89 67.89 1 through 10 Percent of Total Billed Charges 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.85 38.56 44.85 1 through 10 Percent of Total Billed Charges 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 78.21 78.21 78.21 1 through 10 Percent of Total Billed Charges 80 93 93 93 1 through 10 Percent of Total Billed Charges 53 93 93 93 1 through 10 Percent of Total Billed Charges 8.83 8.83 8.83 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.78 40.92 49.29 1 through 10 Percent of Total Billed Charges 53 38.56 38.56 38.56 1 through 10 Percent of Total Billed Charges 4 9 LIPASE 83690 CPT 5400046 CDM 301 RC Facility Outpatient 12 6 73 67.89 67.89 67.89 1 through 10 Percent of Total Billed Charges 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.85 38.56 44.85 1 through 10 Percent of Total Billed Charges 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 78.21 78.21 78.21 1 through 10 Percent of Total Billed Charges 80 93 93 93 1 through 10 Percent of Total Billed Charges 53 93 93 93 1 through 10 Percent of Total Billed Charges 8.83 8.83 8.83 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.78 40.92 49.29 1 through 10 Percent of Total Billed Charges 53 38.56 38.56 38.56 1 through 10 Percent of Total Billed Charges 4 9 LIPOPROTEIN 83695 CPT 5000881 CDM 301 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 99 LIPOPROTEIN PHENOTYPE 83701 CPT 5000481 CDM 301 RC Facility Outpatient 146 73 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 128 "NMR, LIPOPROFILE TEST" 83704 CPT 5000696 CDM 301 RC Facility Outpatient 173 86.5 126.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 152 CHOLESTEROL HDL 83718 CPT 5000294 CDM 301 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 CHOLESTEROL LDL 83721 CPT 5000295 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 MAGNESIUM BLOOD 83735 CPT 5000088 CDM 301 RC Facility Outpatient 94 47 73 68.62 68.62 99.64 1 through 10 Percent of Total Billed Charges 53 49.82 49.82 99.64 11 Percent of Total Billed Charges 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.28 18.28 18.28 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 45.33 1 through 10 Percent of Total Billed Charges 7.04 7.04 7.04 1 through 10 Percent of Total Billed Charges 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 80 94 94 94 1 through 10 Percent of Total Billed Charges 53 94 94 94 18 Percent of Total Billed Charges 37.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 49.82 43.24 124.08 1 through 10 Percent of Total Billed Charges 53 43.24 41.36 49.82 84 Percent of Total Billed Charges 53 40.29 38.99 80.58 1 through 10 Percent of Total Billed Charges 37 75 URINE MAGNESIUM 24HR 83735 CPT 5000609 CDM 301 RC Facility Outpatient 44 22 73 68.62 68.62 99.64 1 through 10 Percent of Total Billed Charges 53 49.82 49.82 99.64 11 Percent of Total Billed Charges 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.28 18.28 18.28 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 45.33 1 through 10 Percent of Total Billed Charges 7.04 7.04 7.04 1 through 10 Percent of Total Billed Charges 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 80 94 94 94 1 through 10 Percent of Total Billed Charges 53 94 94 94 18 Percent of Total Billed Charges 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 49.82 43.24 124.08 1 through 10 Percent of Total Billed Charges 53 43.24 41.36 49.82 84 Percent of Total Billed Charges 53 40.29 38.99 80.58 1 through 10 Percent of Total Billed Charges 17 35 MAGNESIUM/ BLOOD 83735 CPT 5400085 CDM 301 RC Facility Outpatient 12 6 73 68.62 68.62 99.64 1 through 10 Percent of Total Billed Charges 53 49.82 49.82 99.64 11 Percent of Total Billed Charges 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.28 18.28 18.28 1 through 10 Percent of Total Billed Charges 53 38.99 38.99 45.33 1 through 10 Percent of Total Billed Charges 7.04 7.04 7.04 1 through 10 Percent of Total Billed Charges 88 79.05 79.05 79.05 1 through 10 Percent of Total Billed Charges 80 94 94 94 1 through 10 Percent of Total Billed Charges 53 94 94 94 18 Percent of Total Billed Charges 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 49.82 43.24 124.08 1 through 10 Percent of Total Billed Charges 53 43.24 41.36 49.82 84 Percent of Total Billed Charges 53 40.29 38.99 80.58 1 through 10 Percent of Total Billed Charges 4 9 MANGANESE WHOLE BLOOD/PLASMA 83785 CPT 5000156 CDM 301 RC Facility Outpatient 390 195 284.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 343.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153 343 MERCURY BLOOD 83825 CPT 5000491 CDM 301 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 URINE METANEPHRINE 24HR 83835 CPT 5000610 CDM 301 RC Facility Outpatient 100 50 73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 METANEPHRINES (PLASMA) 83835 CPT 5000697 CDM 301 RC Facility Outpatient 354 177 258.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 311.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 283.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 283.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139 311 METHADONE 83840 CPT 5000493 CDM 301 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 MYELIN BASIC PROTEIN 83873 CPT 5000501 CDM 301 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 MYOGLOBIN BLOOD 83874 CPT 5000502 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.56 27.37 38.56 1 through 10 Percent of Total Billed Charges 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 MYOGLOBIN URINE 83874 CPT 5000503 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.56 27.37 38.56 1 through 10 Percent of Total Billed Charges 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 .NOT IN USE.BNP 83880 CPT 5000637 CDM 301 RC Facility Outpatient 307 153.5 73 176.66 176.66 176.66 1 through 10 Percent of Total Billed Charges 53 128.26 128.26 128.26 1 through 10 Percent of Total Billed Charges 120.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 194.98 194.98 194.98 1 through 10 Percent of Total Billed Charges 53 100.36 100.36 100.36 1 through 10 Percent of Total Billed Charges 127.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 203.52 203.52 203.52 1 through 10 Percent of Total Billed Charges 245.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 226.6 130.92 242 16 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 245.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 205.7 111.32 319.44 1 through 10 Percent of Total Billed Charges 53 111.32 106.48 128.26 24 Percent of Total Billed Charges 53 103.72 103.72 103.72 1 through 10 Percent of Total Billed Charges 120 245 PROBNP 83880 CPT 5000840 CDM 301 RC Facility Outpatient 242 121 73 176.66 176.66 176.66 1 through 10 Percent of Total Billed Charges 53 128.26 128.26 128.26 1 through 10 Percent of Total Billed Charges 95.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 194.98 194.98 194.98 1 through 10 Percent of Total Billed Charges 53 100.36 100.36 100.36 1 through 10 Percent of Total Billed Charges 100.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 203.52 203.52 203.52 1 through 10 Percent of Total Billed Charges 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 226.6 130.92 242 16 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 205.7 111.32 319.44 1 through 10 Percent of Total Billed Charges 53 111.32 106.48 128.26 24 Percent of Total Billed Charges 53 103.72 103.72 103.72 1 through 10 Percent of Total Billed Charges 95 193 C1 ESTERASE INHBTR NONFUN 83883 CPT 5000297 CDM 301 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 133.76 129.8 133.76 1 through 10 Percent of Total Billed Charges 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 FREE K AND LIGHT CHAINS SERUM 83883 CPT 5000864 CDM 301 RC Facility Outpatient 295 147.5 215.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 133.76 129.8 133.76 1 through 10 Percent of Total Billed Charges 135.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 259 NICOTINE LEVEL 83887 CPT 5000507 CDM 301 RC Facility Outpatient 123 61.5 89.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 NICOTINE URINE 83887 CPT 5000508 CDM 301 RC Facility Outpatient 174 87 127.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 153 NUCLEOTIDASE 5' 83915 CPT 5000510 CDM 301 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 OLIGOCLONAL BANDING 83916 CPT 5000512 CDM 301 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 MMA ORGANIC ACIDS 83918 CPT 5000125 CDM 301 RC Facility Outpatient 232 116 169.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 204 OSMOLALITY SERUM 83930 CPT 5000513 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 29.04 1 through 10 Percent of Total Billed Charges 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 ANTIDIURETIC HORMONE 83930 CPT 5000654 CDM 301 RC Facility Outpatient 81 40.5 59.13 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.93 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 29.04 1 through 10 Percent of Total Billed Charges 37.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 71 DRUG SCREEN SAP 10 + ALCH 83930 CPT 5000655 CDM 301 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 29.04 1 through 10 Percent of Total Billed Charges 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 DRUG SCREEN SAP 10 83930 CPT 5000656 CDM 301 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 29.04 1 through 10 Percent of Total Billed Charges 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 OSMOLALITY URINE 83935 CPT 5000514 CDM 301 RC Facility Outpatient 70 35 51.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 61 OXALATE URINE 83945 CPT 5000516 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 PARATHYROID HORMONE 83970 CPT 5000519 CDM 301 RC Facility Outpatient 89 44.5 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 47.17 47.17 47.17 1 through 10 Percent of Total Billed Charges 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 36.91 36.91 36.91 1 through 10 Percent of Total Billed Charges 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89 89 89 1 through 10 Percent of Total Billed Charges 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 47.17 40.94 47.17 1 through 10 Percent of Total Billed Charges 53 47.17 39.16 47.17 35 Percent of Total Billed Charges 53 36.91 36.91 38.15 1 through 10 Percent of Total Billed Charges 35 78 STOOL PH 83986 CPT 5000155 CDM 301 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 FLUID pH 83986 CPT 5000713 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 PH GASTRIC FLUID 83986 CPT 5400015 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 PH FLUID 83986 CPT 5400117 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 CALPROTECTIN FECAL 83993 CPT 5000846 CDM 301 RC Facility Outpatient 240 120 175.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 211 ACID PHOSPHATASE TOTAL 84060 CPT 5000229 CDM 301 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 PROSTATIC ACID PHOSTATATE 84066 CPT 5000518 CDM 301 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 ALK PHOSPHATASE 84075 CPT 5000038 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 BONE SPECIFIC ALK PHOS 84075 CPT 5000276 CDM 301 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 ALK PHOSPH 84075 CPT 5400043 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALK PHOSPH ISOENZYME 84080 CPT 5000238 CDM 301 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 31.27 31.27 31.27 1 through 10 Percent of Total Billed Charges 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 PHOSPHORUS 84100 CPT 5000522 CDM 301 RC Facility Outpatient 49 24.5 73 51.94 51.94 51.94 1 through 10 Percent of Total Billed Charges 53 25.97 25.97 25.97 1 through 10 Percent of Total Billed Charges 19.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 20.32 6.46 20.32 1 through 10 Percent of Total Billed Charges 53 20.32 20.32 20.32 1 through 10 Percent of Total Billed Charges 6.35 6.35 6.35 1 through 10 Percent of Total Billed Charges 43.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 26.26 26.26 26.26 1 through 10 Percent of Total Billed Charges 53 49 47.64 49 1 through 10 Percent of Total Billed Charges 19.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.97 22.54 41.65 1 through 10 Percent of Total Billed Charges 53 22.54 21.56 25.97 48 Percent of Total Billed Charges 53 20.32 20.32 21 1 through 10 Percent of Total Billed Charges 19 43 URINE PHOSPHORUS 24HR 84105 CPT 5000048 CDM 301 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 URINE PHOSPHORUS 24 HR 84105 CPT 5400051 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PORPHOBILINOGEN QL 84106 CPT 5000050 CDM 301 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 PORPHOBILINOGEN QL 84106 CPT 5400053 CDM 301 RC Facility Outpatient 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PORPHOBILINOGEN QT 84110 CPT 5000021 CDM 301 RC Facility Outpatient 74 37 54.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 65 PORPHOBILINDGEN QT 84110 CPT 5400019 CDM 301 RC Facility Outpatient 15 7.5 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 URINE PORPHYRINS FRACT&QUANT 84120 CPT 5000612 CDM 301 RC Facility Outpatient 146 73 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 128 POTASSIUM SERUM/PLASMA 84132 CPT 5000041 CDM 301 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 22.8 17.6 22.8 1 through 10 Percent of Total Billed Charges 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 POTASSIUM URINE 84133 CPT 5000527 CDM 301 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 PREALBUMIN 84134 CPT 5000528 CDM 301 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 51 51 51 1 through 10 Percent of Total Billed Charges 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 27.03 27.03 27.03 1 through 10 Percent of Total Billed Charges 53 27.03 23.46 45 1 through 10 Percent of Total Billed Charges 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 PROGESTERONE 84144 CPT 5000532 CDM 301 RC Facility Outpatient 139 69.5 73 101.47 101.47 101.47 1 through 10 Percent of Total Billed Charges 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 61.16 61.16 61.16 1 through 10 Percent of Total Billed Charges 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 PROCALCITONIN 84145 CPT 5000833 CDM 301 RC Facility Outpatient 324 162 236.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.72 171.72 171.72 1 through 10 Percent of Total Billed Charges 127.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 142.56 142.56 142.56 1 through 10 Percent of Total Billed Charges 53 171.72 142.56 171.72 1 through 10 Percent of Total Billed Charges 149.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127 285 PROLACTIN 84146 CPT 5000533 CDM 301 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 PSA TOTAL 84153 CPT 5000541 CDM 301 RC Facility Outpatient 133 66.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 53 70.49 70.49 70.49 1 through 10 Percent of Total Billed Charges 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 63.88 63.88 133 1 through 10 Percent of Total Billed Charges 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 113.05 113.05 113.05 1 through 10 Percent of Total Billed Charges 53 70.49 58.52 70.49 1 through 10 Percent of Total Billed Charges 53 55.15 55.15 55.15 1 through 10 Percent of Total Billed Charges 52 117 PSA SCREENING 84153 CPT 5006633 CDM 301 RC Facility Outpatient 133 66.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 53 70.49 70.49 70.49 1 through 10 Percent of Total Billed Charges 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 63.88 63.88 133 1 through 10 Percent of Total Billed Charges 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 113.05 113.05 113.05 1 through 10 Percent of Total Billed Charges 53 70.49 58.52 70.49 1 through 10 Percent of Total Billed Charges 53 55.15 55.15 55.15 1 through 10 Percent of Total Billed Charges 52 117 PSA SCREENING SPECIAL 84153 CPT 5006634 CDM 301 RC Facility Outpatient 78 39 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 53 70.49 70.49 70.49 1 through 10 Percent of Total Billed Charges 30.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 63.88 63.88 133 1 through 10 Percent of Total Billed Charges 31.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 113.05 113.05 113.05 1 through 10 Percent of Total Billed Charges 53 70.49 58.52 70.49 1 through 10 Percent of Total Billed Charges 53 55.15 55.15 55.15 1 through 10 Percent of Total Billed Charges 30 68 PSA FREE 84154 CPT 5000758 CDM 301 RC Facility Outpatient 191 95.5 139.43 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.23 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 101.23 101.23 101.23 1 through 10 Percent of Total Billed Charges 87.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 168 PROTEIN TOTAL SERUM 84155 CPT 5000539 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 28.29 1 through 10 Percent of Total Billed Charges 26 58 PROTEIN BODY FLUID 84155 CPT 5000540 CDM 301 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 28.29 1 through 10 Percent of Total Billed Charges 8 19 PROTEIN URINE RANDOM 84155 CPT 5000648 CDM 307 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 28.29 1 through 10 Percent of Total Billed Charges 26 58 PROTEIN/PLEURAL TOTAL 84155 CPT 5000653 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 28.29 1 through 10 Percent of Total Billed Charges 26 58 CSF PROTEIN 84155 CPT 5400078 CDM 301 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 28.29 1 through 10 Percent of Total Billed Charges 2 6 PROTEIN URINE 24 HR 84156 CPT 5000536 CDM 301 RC Facility Outpatient 107 53.5 78.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.71 56.71 56.71 1 through 10 Percent of Total Billed Charges 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 107 107 107 1 through 10 Percent of Total Billed Charges 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.22 47.08 56.71 1 through 10 Percent of Total Billed Charges 53 44.37 44.37 44.37 1 through 10 Percent of Total Billed Charges 42 94 PROTEIN FLUID 84157 CPT 5000081 CDM 301 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 SERUM IMM ELECTROPHORESIS 84165 CPT 5000568 CDM 301 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 47 47 47 1 through 10 Percent of Total Billed Charges 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.62 21.62 21.62 1 through 10 Percent of Total Billed Charges 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 PROTEIN ELECTROPHOR 84165 CPT 5400072 CDM 301 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 47 47 47 1 through 10 Percent of Total Billed Charges 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.62 21.62 21.62 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 URINE PROTEIN ELECTRO 84166 CPT 5000613 CDM 301 RC Facility Outpatient 116 58 84.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 61.48 61.48 61.48 1 through 10 Percent of Total Billed Charges 45.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 102 "PROTEIN ELECTRO, RANDOM URINE" 84166 CPT 5000831 CDM 302 RC Facility Outpatient 165 82.5 120.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 61.48 61.48 61.48 1 through 10 Percent of Total Billed Charges 65.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 145 ANTI HU ANTINEURONAL CELL AB 84182 CPT 5000006 CDM 302 RC Facility Outpatient 355 177.5 259.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139 312 VITAMIN B6 84207 CPT 5000619 CDM 301 RC Facility Outpatient 293 146.5 213.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 155.29 155.29 155.29 1 through 10 Percent of Total Billed Charges 115.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.51 29.51 29.51 1 through 10 Percent of Total Billed Charges 257.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 234.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 155.29 155.29 155.29 1 through 10 Percent of Total Billed Charges 134.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 257 RECEPTOR ASSAY; ESTROGEN 84233 CPT 5000550 CDM 301 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 RECEPTOR ASSAY- PROGESTERONE 84234 CPT 5000117 CDM 301 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 RECEPTOR ASSAY - PROGESTERONE 84234 CPT 5400116 CDM 301 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 ACETYLCHOLINE RECEPTOR AB 84238 CPT 5000096 CDM 301 RC Facility Outpatient 278 139 202.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109 244 ACETYLOCHOLINE RECEPTOR AB 84238 CPT 5400094 CDM 301 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 RENIN ACTIVITY SINGLE 84244 CPT 5000551 CDM 301 RC Facility Outpatient 144 72 105.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 126 HYPOGLYCEMIC PANEL 84252 CPT 5400121 CDM 301 RC Facility Outpatient 88 44 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 SELENIUM 84255 CPT 5000855 CDM 301 RC Facility Outpatient 154 77 112.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 135 SEROTONIN 84260 CPT 5000565 CDM 301 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 "SEX HORMONE BINDING GLOBULIN, SERUM" 84270 CPT 5000675 CDM 302 RC Facility Outpatient 123 61.5 73 89.79 89.79 89.79 1 through 10 Percent of Total Billed Charges 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.65 29.65 29.65 1 through 10 Percent of Total Billed Charges 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 SODIUM SERUM 84295 CPT 5000575 CDM 301 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 SODIUM URINE 84300 CPT 5000576 CDM 301 RC Facility Outpatient 56 28 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 URINE NA 84300 CPT 5400057 CDM 301 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 SODIUM BODY FLUID 84302 CPT 5000667 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 SODIUM BODY FLUID 84302 CPT 5000740 CDM 301 RC Facility Outpatient 105 52.5 76.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 92 IGF-BP1 84305 CPT 5000139 CDM 301 RC Facility Outpatient 111 55.5 81.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 97 IGF-I 84305 CPT 5000702 CDM 301 RC Facility Outpatient 244 122 178.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 214 CHOLESTEROL FLUID 84311 CPT 5000856 CDM 301 RC Facility Outpatient 58 29 42.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 51 SPEC GRAV BODY FLUID 84315 CPT 5000020 CDM 301 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SPEC GRAV BODY FLUID 84315 CPT 5400018 CDM 301 RC Facility Outpatient 5 2.5 3.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 4 STOOL REDUCING SUBSTANCES 84376 CPT 5000154 CDM 301 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 GLYCOMARK 84378 CPT 5000756 CDM 301 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 FREE TESTOSTERONE 84402 CPT 5000175 CDM 301 RC Facility Outpatient 57 28.5 73 41.61 41.61 41.61 1 through 10 Percent of Total Billed Charges 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 30.21 30.21 30.21 1 through 10 Percent of Total Billed Charges 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 TESTOSTERONE TOTAL 84403 CPT 5000026 CDM 301 RC Facility Outpatient 85 42.5 73 62.05 62.05 62.05 1 through 10 Percent of Total Billed Charges 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 35.22 35.22 35.22 1 through 10 Percent of Total Billed Charges 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.05 45.05 45.05 1 through 10 Percent of Total Billed Charges 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 TESTOSTERONE TOTAL 84403 CPT 5400026 CDM 301 RC Facility Outpatient 43 21.5 73 62.05 62.05 62.05 1 through 10 Percent of Total Billed Charges 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 35.22 35.22 35.22 1 through 10 Percent of Total Billed Charges 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.05 45.05 45.05 1 through 10 Percent of Total Billed Charges 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 37 VITAMIN B1(THIAMINE) 84425 CPT 5000649 CDM 307 RC Facility Outpatient 78 39 56.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 68 CCP IGG AB 84425 CPT 5000650 CDM 307 RC Facility Outpatient 56 28 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 T4 84436 CPT 5000589 CDM 301 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 48.76 48.76 48.76 1 through 10 Percent of Total Billed Charges 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.15 38.15 38.15 1 through 10 Percent of Total Billed Charges 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 78.2 78.2 78.2 1 through 10 Percent of Total Billed Charges 53 40.48 40.48 40.48 1 through 10 Percent of Total Billed Charges 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 FREE T4 84439 CPT 5000397 CDM 301 RC Facility Outpatient 91 45.5 73 66.43 66.43 66.43 1 through 10 Percent of Total Billed Charges 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.88 37.74 43.88 1 through 10 Percent of Total Billed Charges 37.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 91 91 91 1 through 10 Percent of Total Billed Charges 11.57 11.57 11.57 1 through 10 Percent of Total Billed Charges 72.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 48.23 48.23 48.23 1 through 10 Percent of Total Billed Charges 53 48.23 40.04 48.23 17 Percent of Total Billed Charges 41.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 80 TSH ULTRA SENS 84443 CPT 5000602 CDM 301 RC Facility Outpatient 120 60 73 87.6 63.6 87.6 14 Percent of Total Billed Charges 53 63.6 63.6 63.6 11 Percent of Total Billed Charges 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.76 49.76 49.76 1 through 10 Percent of Total Billed Charges 53 49.76 49.76 57.86 1 through 10 Percent of Total Billed Charges 17.64 17.64 72.02 1 through 10 Percent of Total Billed Charges 88 100.92 100.92 100.92 1 through 10 Percent of Total Billed Charges 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 120 22.28 120 21 Percent of Total Billed Charges 21.54 21.54 21.54 1 through 10 Percent of Total Billed Charges 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 63.6 52.8 105.6 14 Percent of Total Billed Charges 53 55.2 52.8 63.6 52 Percent of Total Billed Charges 53 49.76 49.76 51.44 1 through 10 Percent of Total Billed Charges 47 96 THYROID STIMULATING IMMUNOGLOBULIN (TSI) 84445 CPT 5000678 CDM 302 RC Facility Outpatient 297 148.5 216.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 123.16 123.16 123.16 1 through 10 Percent of Total Billed Charges 122.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 225.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 261 VITAMIN E 84446 CPT 5000621 CDM 301 RC Facility Outpatient 48 24 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 42 AST/SGOT 84450 CPT 5000039 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 ALTI 84460 CPT 5000042 CDM 301 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 SGPT 84460 CPT 5400045 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TRANSFERRIN SERUM 84466 CPT 5000076 CDM 301 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 TRANSFERRIN SERUM 84466 CPT 5400073 CDM 301 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 TRIGLYCERIDES 84478 CPT 5000601 CDM 301 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 99 TRIGLYCERIDES FLUID 84478 CPT 5000857 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 T3 UPTAKE 84479 CPT 5000581 CDM 301 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.56 43.56 43.56 1 through 10 Percent of Total Billed Charges 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 T3 TOTAL SERUM 84480 CPT 5000580 CDM 301 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 13.69 13.69 13.69 1 through 10 Percent of Total Billed Charges 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 28.05 28.05 28.05 1 through 10 Percent of Total Billed Charges 53 15.18 14.52 17.49 1 through 10 Percent of Total Billed Charges 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 "TRIIODOTHYROXINE, FREE (FREE T3)" 84481 CPT 5000677 CDM 302 RC Facility Outpatient 205 102.5 149.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 98.85 98.85 98.85 1 through 10 Percent of Total Billed Charges 84.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 172.41 172.41 172.41 1 through 10 Percent of Total Billed Charges 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 108.65 108.65 108.65 1 through 10 Percent of Total Billed Charges 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 164 T3 REVERSE 84482 CPT 5000579 CDM 300 RC Facility Outpatient 178 89 129.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70 156 TNIH 84484 CPT 5000007 CDM 301 RC Facility Outpatient 190 95 73 100.7 100.7 138.7 1 through 10 Percent of Total Billed Charges 53 100.7 100.7 201.4 15 Percent of Total Billed Charges 74.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 78.79 78.79 153.08 1 through 10 Percent of Total Billed Charges 53 78.79 78.79 157.59 1 through 10 Percent of Total Billed Charges 13 13 13 1 through 10 Percent of Total Billed Charges 88 159.79 159.79 319.58 1 through 10 Percent of Total Billed Charges 80 190 190 190 1 through 10 Percent of Total Billed Charges 53 190 95 190 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 152 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 100.7 83.6 161.5 1 through 10 Percent of Total Billed Charges 53 87.4 83.6 190 56 Percent of Total Billed Charges 53 78.79 78.79 162.86 1 through 10 Percent of Total Billed Charges 74 152 BUN 84520 CPT 5000632 CDM 301 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 UREA NITROGEN BODY FLUID 84520 CPT 5000671 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 BUN TEST 84520 CPT 5006632 CDM 301 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 URINE UREA NITROGEN 24HR 84540 CPT 5000109 CDM 301 RC Facility Outpatient 144 72 105.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 126 UREA NITROGEN (U) 84540 CPT 5000604 CDM 301 RC Facility Outpatient 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 URINE UREA NITROGEN - 24 HR 84540 CPT 5400108 CDM 301 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 UREA CLEARANCE 84545 CPT 5000603 CDM 301 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 URIC ACID 84550 CPT 5000605 CDM 301 RC Facility Outpatient 59 29.5 73 43.07 43.07 43.07 1 through 10 Percent of Total Billed Charges 53 31.27 31.27 31.27 11 Percent of Total Billed Charges 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 6.16 6.16 6.16 1 through 10 Percent of Total Billed Charges 53 24.46 24.46 24.46 1 through 10 Percent of Total Billed Charges 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 59 59 59 13 Percent of Total Billed Charges 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 31.27 27.14 50.15 1 through 10 Percent of Total Billed Charges 53 31.27 25.96 31.27 28 Percent of Total Billed Charges 53 24.46 24.46 25.29 1 through 10 Percent of Total Billed Charges 23 51 URIC ACID UR 24HR 84560 CPT 5000606 CDM 301 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 URIC ACID FLUID 84560 CPT 5000858 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 URINE VMA 24HR 84585 CPT 5000090 CDM 301 RC Facility Outpatient 120 60 87.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 URINE VMA 24 HR 84585 CPT 5400087 CDM 301 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 VITAMIN - A 84590 CPT 5000692 CDM 301 RC Facility Outpatient 124 62 90.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 109 ALPHA 1-ANTITRYPSIN 84590 CPT 5000693 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 VITAMIN K 84597 CPT 5000694 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 ALCOHOL ISOPROPYL 84600 CPT 5000234 CDM 301 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 D-XYLOSE 84620 CPT 5000372 CDM 301 RC Facility Outpatient 119 59.5 86.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 104 ZINC PLASMA 84630 CPT 5000627 CDM 301 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 C-PEPTIDE 84681 CPT 5000315 CDM 301 RC Facility Outpatient 137 68.5 100.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.81 56.81 56.81 1 through 10 Percent of Total Billed Charges 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72.61 72.61 72.61 1 through 10 Percent of Total Billed Charges 63.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 120 PREGNANCY QUANT HCG 84702 CPT 5000529 CDM 301 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 PREGNANCY SERUM QUAL 84703 CPT 5000053 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53.18 27.37 190.96 1 through 10 Percent of Total Billed Charges 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 7.9 7.9 7.9 12 Percent of Total Billed Charges 88 55.51 33 55.51 1 through 10 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 8.23 100 24 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 56.1 1 through 10 Percent of Total Billed Charges 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 52 PREGNANCY URINE QUAL 84703 CPT 5000645 CDM 301 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53.18 27.37 190.96 1 through 10 Percent of Total Billed Charges 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 7.9 7.9 7.9 12 Percent of Total Billed Charges 88 55.51 33 55.51 1 through 10 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 8.23 100 24 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 56.1 1 through 10 Percent of Total Billed Charges 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 52 PREGNANCY SERUM/URINE QU 84703 CPT 5400055 CDM 301 RC Facility Outpatient 15 7.5 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53.18 27.37 190.96 1 through 10 Percent of Total Billed Charges 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 7.9 7.9 7.9 12 Percent of Total Billed Charges 88 55.51 33 55.51 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 8.23 100 24 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 29.04 56.1 1 through 10 Percent of Total Billed Charges 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 PANCREATIC ISO 84999 CPT 5000114 CDM 301 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 SALIVARY ISO 84999 CPT 5000115 CDM 301 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MACRO AMYLASE QUALITATIVE 84999 CPT 5000116 CDM 301 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 POTASSIUM BODY FLUID 84999 CPT 5000666 CDM 301 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 POTASSIUM FECAL 84999 CPT 5000738 CDM 301 RC Facility Outpatient 105 52.5 76.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 92 OSMOLALITY FECAL 84999 CPT 5000757 CDM 301 RC Facility Outpatient 68 34 49.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 59 BLEEDING TIME 85002 CPT 5000274 CDM 305 RC Facility Outpatient 105 52.5 76.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 92 .DIFF MANUAL CHARGE 85007 CPT 5000058 CDM 305 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 23.32 23.32 23.32 1 through 10 Percent of Total Billed Charges 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 37 37 37 1 through 10 Percent of Total Billed Charges 80 44 44 44 1 through 10 Percent of Total Billed Charges 53 44 44 44 1 through 10 Percent of Total Billed Charges 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 23.32 19.36 23.32 1 through 10 Percent of Total Billed Charges 53 18.25 18.25 18.25 1 through 10 Percent of Total Billed Charges 17 35 DIFFERENTIAL MANUAL 85007 CPT 5400059 CDM 305 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 23.32 23.32 23.32 1 through 10 Percent of Total Billed Charges 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 37 37 37 1 through 10 Percent of Total Billed Charges 80 44 44 44 1 through 10 Percent of Total Billed Charges 53 44 44 44 1 through 10 Percent of Total Billed Charges 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 23.32 19.36 23.32 1 through 10 Percent of Total Billed Charges 53 18.25 18.25 18.25 1 through 10 Percent of Total Billed Charges 2 5 BLOOD SMEAR EXAM 85008 CPT 5000275 CDM 305 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 PLATELET EST 85008 CPT 5000526 CDM 305 RC Facility Outpatient 18 9 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 HEMATOCRIT - NOT SPUN 85014 CPT 5000423 CDM 305 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 8.3 8.3 8.3 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 16.82 16.82 16.82 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 10.6 10.6 10.6 1 through 10 Percent of Total Billed Charges 53 8.3 8.3 8.3 1 through 10 Percent of Total Billed Charges 7 16 HEMOGLOBIN BLOOD 85018 CPT 5000424 CDM 305 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 8.3 8.3 8.3 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 16.82 16.82 16.82 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 10.6 10.6 10.6 1 through 10 Percent of Total Billed Charges 53 8.3 8.3 8.3 1 through 10 Percent of Total Billed Charges 7 16 .HEMOGRAM W/AUTO DIFF CHARGE 85025 CPT 5000085 CDM 305 RC Facility Outpatient 72 36 73 52.56 38.16 52.56 38 Percent of Total Billed Charges 53 38.16 38.16 38.16 55 Percent of Total Billed Charges 9.77 9.77 9.77 1 through 10 Percent of Total Billed Charges 53 10.61 9.59 58.01 23 Percent of Total Billed Charges 53 29.86 29.86 29.86 28 Percent of Total Billed Charges 8.16 8.16 31.35 17 Percent of Total Billed Charges 88 60.55 60.55 60.55 12 Percent of Total Billed Charges 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72 53.27 72 17 Percent of Total Billed Charges 9.97 9.97 100 28 Percent of Total Billed Charges 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 61.2 31.68 63.36 34 Percent of Total Billed Charges 53 33.12 31.68 38.16 276 Percent of Total Billed Charges 53 29.86 29.86 30.86 31 Percent of Total Billed Charges 57 57 HEMOGRAM W/ DIFF 85025 CPT 5400083 CDM 305 RC Facility Outpatient 13 6.5 73 52.56 38.16 52.56 38 Percent of Total Billed Charges 53 38.16 38.16 38.16 55 Percent of Total Billed Charges 9.77 9.77 9.77 1 through 10 Percent of Total Billed Charges 53 10.61 9.59 58.01 23 Percent of Total Billed Charges 53 29.86 29.86 29.86 28 Percent of Total Billed Charges 8.16 8.16 31.35 17 Percent of Total Billed Charges 88 60.55 60.55 60.55 12 Percent of Total Billed Charges 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72 53.27 72 17 Percent of Total Billed Charges 9.97 9.97 100 28 Percent of Total Billed Charges 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 61.2 31.68 63.36 34 Percent of Total Billed Charges 53 33.12 31.68 38.16 276 Percent of Total Billed Charges 53 29.86 29.86 30.86 31 Percent of Total Billed Charges 10 10 HEMOGRAM WITH PLT 85027 CPT 5000049 CDM 305 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 39.53 39.53 39.53 1 through 10 Percent of Total Billed Charges 80 47 47 47 1 through 10 Percent of Total Billed Charges 53 47 47 47 1 through 10 Percent of Total Billed Charges 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 20.68 24.91 1 through 10 Percent of Total Billed Charges 53 19.49 19.49 19.49 1 through 10 Percent of Total Billed Charges 18 37 .HEMOGRAM/PLT CHARGE 85027 CPT 5000106 CDM 305 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 24.91 24.91 1 through 10 Percent of Total Billed Charges 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 39.53 39.53 39.53 1 through 10 Percent of Total Billed Charges 80 47 47 47 1 through 10 Percent of Total Billed Charges 53 47 47 47 1 through 10 Percent of Total Billed Charges 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.91 20.68 24.91 1 through 10 Percent of Total Billed Charges 53 19.49 19.49 19.49 1 through 10 Percent of Total Billed Charges 18 37 PLATELET COUNT MANUAL 85032 CPT 5000525 CDM 305 RC Facility Outpatient 53 26.5 38.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 46 RBC AUTO 85041 CPT 5000549 CDM 305 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 RETICULOCYTE COUNT MANUAL 85044 CPT 5000552 CDM 305 RC Facility Outpatient 62 31 45.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 54 EOSINOPHIL COUNT 85048 CPT 5000381 CDM 302 RC Facility Outpatient 40 20 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 WBC 85048 CPT 5000622 CDM 305 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 PLATELET COUNT 85049 CPT 5000643 CDM 301 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 FACTOR V LEIDEN MUTATION 85210 CPT 5400064 CDM 305 RC Facility Outpatient 860 430 627.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 455.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 355.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 756.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 688 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 688 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 653.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338 756 FACTOR 5 85220 CPT 5000063 CDM 305 RC Facility Outpatient 218 109 159.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 FACTOR 7 85230 CPT 5000148 CDM 305 RC Facility Outpatient 217 108.5 158.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 190 FACTOR 8 85240 CPT 5000102 CDM 305 RC Facility Outpatient 209 104.5 152.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82 183 COAG FACT 8 85240 CPT 5400100 CDM 305 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 FACTOR 8 R-AG 85244 CPT 5000022 CDM 305 RC Facility Outpatient 265 132.5 193.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 233 COAG FACTOR 8 R-AG 85244 CPT 5400022 CDM 305 RC Facility Outpatient 34 17 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 FACTOR VIII ACT - RISTOCTIN 85245 CPT 5000023 CDM 305 RC Facility Outpatient 218 109 159.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 RISTOCTIN COFACTOR 85245 CPT 5400021 CDM 305 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 COAG FACTOR VIII ACT 85245 CPT 5400023 CDM 305 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 FACTOR 9 85250 CPT 5000103 CDM 305 RC Facility Outpatient 243 121.5 177.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 213 COAG FACTOR 9 85250 CPT 5400101 CDM 305 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 FACTOR 10 85260 CPT 5000104 CDM 305 RC Facility Outpatient 239 119.5 174.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 210 COAG FACTOR 10 85260 CPT 5400102 CDM 305 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 ANTITHROMBIN III 85300 CPT 5000257 CDM 305 RC Facility Outpatient 518 259 378.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 455.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 414.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 414.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204 455 PROTEIN C DEFICIENCY PROFILE 85303 CPT 5000537 CDM 305 RC Facility Outpatient 228 114 166.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 200 PROTEIN S ANTIGEN 85305 CPT 5000173 CDM 305 RC Facility Outpatient 111 55.5 81.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 97 FREE PROTEIN S LEVEL 85306 CPT 5000174 CDM 305 RC Facility Outpatient 269 134.5 196.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105 236 PROTEIN S FREE 85306 CPT 5000538 CDM 305 RC Facility Outpatient 240 120 175.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 211 CLOTTING TIME LEE & WHITE 85345 CPT 5000300 CDM 305 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 FIBRIN SPLIT PROD 85362 CPT 5000393 CDM 305 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 D-DIMER QUANT 85379 CPT 5000012 CDM 305 RC Facility Outpatient 106 53 73 56.18 56.18 77.38 1 through 10 Percent of Total Billed Charges 53 56.18 56.18 56.18 1 through 10 Percent of Total Billed Charges 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.96 13.89 85.4 1 through 10 Percent of Total Billed Charges 53 43.96 43.96 43.96 1 through 10 Percent of Total Billed Charges 10.69 10.69 10.69 1 through 10 Percent of Total Billed Charges 88 89.15 89.15 89.15 1 through 10 Percent of Total Billed Charges 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.75 42.75 42.75 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 56.18 46.64 90.1 1 through 10 Percent of Total Billed Charges 53 48.76 46.64 56.18 24 Percent of Total Billed Charges 53 45.44 43.96 45.44 1 through 10 Percent of Total Billed Charges 41 84 QUANTITATIVE D-DIMER (QUANT D-DIMER) 85379 CPT 5000704 CDM 301 RC Facility Outpatient 191 95.5 73 56.18 56.18 77.38 1 through 10 Percent of Total Billed Charges 53 56.18 56.18 56.18 1 through 10 Percent of Total Billed Charges 75.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.96 13.89 85.4 1 through 10 Percent of Total Billed Charges 53 43.96 43.96 43.96 1 through 10 Percent of Total Billed Charges 10.69 10.69 10.69 1 through 10 Percent of Total Billed Charges 88 89.15 89.15 89.15 1 through 10 Percent of Total Billed Charges 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.75 42.75 42.75 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 152.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 56.18 46.64 90.1 1 through 10 Percent of Total Billed Charges 53 48.76 46.64 56.18 24 Percent of Total Billed Charges 53 45.44 43.96 45.44 1 through 10 Percent of Total Billed Charges 75 152 D DIMER QUANT 85379 CPT 5400006 CDM 305 RC Facility Outpatient 17 8.5 73 56.18 56.18 77.38 1 through 10 Percent of Total Billed Charges 53 56.18 56.18 56.18 1 through 10 Percent of Total Billed Charges 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.96 13.89 85.4 1 through 10 Percent of Total Billed Charges 53 43.96 43.96 43.96 1 through 10 Percent of Total Billed Charges 10.69 10.69 10.69 1 through 10 Percent of Total Billed Charges 88 89.15 89.15 89.15 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.75 42.75 42.75 1 through 10 Percent of Total Billed Charges 100 100 100 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 56.18 46.64 90.1 1 through 10 Percent of Total Billed Charges 53 48.76 46.64 56.18 24 Percent of Total Billed Charges 53 45.44 43.96 45.44 1 through 10 Percent of Total Billed Charges 6 13 FIBRINOGEN 85384 CPT 5000394 CDM 305 RC Facility Outpatient 87 43.5 63.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 76 PLASMINOGEN ACTIVITY 85420 CPT 5000524 CDM 305 RC Facility Outpatient 243 121.5 177.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 213 HEPARIN ASSAY 85520 CPT 5000873 CDM 301 RC Facility Outpatient 312 156 227.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122 274 LEUKOCYTE ALK PHOS 85540 CPT 5000479 CDM 305 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 LUPUS ANITCOAGULANT 85610 CPT 5400099 CDM 305 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 PT w / INR 85611 CPT 5000060 CDM 305 RC Facility Outpatient 66 33 73 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 53 34.98 34.98 34.98 1 through 10 Percent of Total Billed Charges 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 27.37 27.37 53.18 1 through 10 Percent of Total Billed Charges 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 55.51 55.51 55.51 1 through 10 Percent of Total Billed Charges 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 29.04 22.88 66 1 through 10 Percent of Total Billed Charges 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 56.1 29.04 56.1 1 through 10 Percent of Total Billed Charges 53 34.98 29.04 34.98 20 Percent of Total Billed Charges 53 27.37 27.37 27.37 1 through 10 Percent of Total Billed Charges 26 52 SED RATE MANUAL 85651 CPT 5000059 CDM 305 RC Facility Outpatient 57 28.5 73 30.21 30.21 30.21 1 through 10 Percent of Total Billed Charges 53 30.21 30.21 30.21 1 through 10 Percent of Total Billed Charges 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.84 4.84 4.84 1 through 10 Percent of Total Billed Charges 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 22.44 22.44 22.44 1 through 10 Percent of Total Billed Charges 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 48.45 25.08 48.45 1 through 10 Percent of Total Billed Charges 53 30.21 25.08 30.21 12 Percent of Total Billed Charges 53 23.64 23.64 23.64 1 through 10 Percent of Total Billed Charges 22 50 SED RATE NON-AUTOMATED 85651 CPT 5400060 CDM 305 RC Facility Outpatient 7 3.5 73 30.21 30.21 30.21 1 through 10 Percent of Total Billed Charges 53 30.21 30.21 30.21 1 through 10 Percent of Total Billed Charges 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.84 4.84 4.84 1 through 10 Percent of Total Billed Charges 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 22.44 22.44 22.44 1 through 10 Percent of Total Billed Charges 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 48.45 25.08 48.45 1 through 10 Percent of Total Billed Charges 53 30.21 25.08 30.21 12 Percent of Total Billed Charges 53 23.64 23.64 23.64 1 through 10 Percent of Total Billed Charges 2 6 SICKLE CELL SCREEN 85660 CPT 5000570 CDM 305 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 SICKLE CELL PREP 85660 CPT 5400103 CDM 305 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 THROMBIN TIME TITER 85675 CPT 5000585 CDM 305 RC Facility Outpatient 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 PTT 85730 CPT 5000028 CDM 305 RC Facility Outpatient 75 37.5 73 39.75 39.75 39.75 1 through 10 Percent of Total Billed Charges 53 39.75 39.75 39.75 1 through 10 Percent of Total Billed Charges 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 31.1 31.1 60.43 1 through 10 Percent of Total Billed Charges 53 31.1 31.1 31.1 1 through 10 Percent of Total Billed Charges 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 63.08 63.08 63.08 1 through 10 Percent of Total Billed Charges 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 63.75 33 63.75 1 through 10 Percent of Total Billed Charges 53 34.5 33 39.75 17 Percent of Total Billed Charges 53 31.1 31.1 31.1 1 through 10 Percent of Total Billed Charges 29 60 LUPUS ANTICOAGULANT 85732 CPT 5000101 CDM 305 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 SERUM VISCOSITY 85810 CPT 5000844 CDM 301 RC Facility Outpatient 88 44 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 FEBRILE AGGLUTIN - EACH AG 86000 CPT 5000387 CDM 302 RC Facility Outpatient 106 53 77.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 93 ROCKY MTN SPOTTED FEVER 86000 CPT 5000556 CDM 302 RC Facility Outpatient 124 62 90.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 109 ANIMAL ALLERGY PRF 86003 CPT 5000254 CDM 302 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 MOLD ALLERGY PRF 86003 CPT 5000497 CDM 302 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 "GREEN BELL PEPPER ALLERGEN, IGE" 86003 CPT 5000679 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "TOMATO ALLERGEN, IGE" 86003 CPT 5000680 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "LETTUCE ALLERGEN, IGE" 86003 CPT 5000681 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "CARROT ALLERGEN, IGE" 86003 CPT 5000682 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "CHICKEN ALLERGEN, IGE" 86003 CPT 5000683 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "PEANUT ALLERGEN, IGE" 86003 CPT 5000684 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "BRAZIL NUT ALLERGEN, IGE" 86003 CPT 5000685 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "LATEX ALLERGEN, IGE" 86003 CPT 5000686 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "LOBSTER ALLERGEN, IGE" 86003 CPT 5000687 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 "CRAB ALLERGEN, IGE" 86003 CPT 5000688 CDM 302 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 ZONE 8 ALLERGENS 86003 CPT 5000689 CDM 302 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 FOOD ALLERGEN BASIC PANEL 86003 CPT 5000735 CDM 300 RC Facility Outpatient 148 74 108.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 68.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 130 ALPHA GAL PANEL 86003 CPT 5000867 CDM 301 RC Facility Outpatient 125 62.5 91.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 MILK COMPONENT PANEL 86003 CPT 5000884 CDM 301 RC Facility Outpatient 237 118.5 173.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 109.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 208 IMMUNOCAP 86003 CPT 5000897 CDM 301 RC Facility Outpatient 444 222 324.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 235.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 390.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 355.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 355.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 337.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 204.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174 390 REGION 2 ALLERGY PRF 86003 CPT 5400020 CDM 302 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 55 55 55 1 through 10 Percent of Total Billed Charges 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RAST IND ALLERGENN 86005 CPT 5000546 CDM 302 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 RAST PANEL 86005 CPT 5000547 CDM 302 RC Facility Outpatient 337 168.5 246.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 296 AUTO PLT ABS 86022 CPT 5000264 CDM 302 RC Facility Outpatient 204 102 148.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 179 HEPARIN INDUCED PLATELET 86022 CPT 5000861 CDM 301 RC Facility Outpatient 306 153 223.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 269 ANTINUCLEAR ANTIBODIES 86038 CPT 5000803 CDM 300 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 46 44 46 1 through 10 Percent of Total Billed Charges 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 ANA / IFA 86038 CPT 5000876 CDM 301 RC Facility Outpatient 100 50 73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 46 44 46 1 through 10 Percent of Total Billed Charges 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 ANA TITER 86039 CPT 5000252 CDM 302 RC Facility Outpatient 89 44.5 73 47.17 47.17 47.17 1 through 10 Percent of Total Billed Charges 53 47.17 47.17 47.17 1 through 10 Percent of Total Billed Charges 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 MYASTHENIA GRAVIS EVAL PROFILE 86041 CPT 5000916 CDM 300 RC Facility Outpatient 1110.9 555.45 810.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 588.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 459.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 977.59 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 888.72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 446.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 888.72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 844.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437 977 ASO TITER 86060 CPT 5000261 CDM 302 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 ASO SCREEN 86063 CPT 5000260 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 STREPTOZYME 86063 CPT 5400109 CDM 302 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 BB PHYSICIAN SERVICE CROSSMATCH 86077 CPT 5600054 CDM 391 RC Facility Outpatient 158 79 115.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 C-REACT PROT 86140 CPT 5000319 CDM 302 RC Facility Outpatient 82 41 59.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 43.46 43.46 43.46 1 through 10 Percent of Total Billed Charges 32.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 7.06 7.06 7.06 1 through 10 Percent of Total Billed Charges 53 34 34 34 1 through 10 Percent of Total Billed Charges 5.44 5.44 5.44 1 through 10 Percent of Total Billed Charges 72.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82 82 82 1 through 10 Percent of Total Billed Charges 32.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 69.7 69.7 69.7 1 through 10 Percent of Total Billed Charges 53 43.46 36.08 43.46 11 Percent of Total Billed Charges 53 35.15 34 35.15 1 through 10 Percent of Total Billed Charges 32 72 BETA 2 GLYCOPROTEIN 1 AB 86146 CPT 5000886 CDM 301 RC Facility Outpatient 306 153 223.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 134.64 134.64 134.64 1 through 10 Percent of Total Billed Charges 140.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 269 CARDIOLIPIN ANTIBODIES PHOSPHOLIPIDS 86147 CPT 5000105 CDM 302 RC Facility Outpatient 159 79.5 116.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 ANTIPHOSPHALIPIDS 86147 CPT 5000709 CDM 301 RC Facility Outpatient 338 169 246.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 270.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 270.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133 297 PHOSPHOLIPIDS ANTIBODY 86147 CPT 5400097 CDM 302 RC Facility Outpatient 43 21.5 31.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 37 CARDIOLIPIN ANTIBODIES 86147 CPT 5400104 CDM 302 RC Facility Outpatient 43 21.5 31.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 37 COLD AGGLUTININS 86156 CPT 5000306 CDM 302 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 C1 ESTERASE INHIBITOR LEVEL (F 86160 CPT 5000298 CDM 302 RC Facility Outpatient 127 63.5 92.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 50.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 51.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 58.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 111 COMPLEMENT C4 86160 CPT 5000308 CDM 302 RC Facility Outpatient 123 61.5 89.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 COMPLIMENT C3 86160 CPT 5000310 CDM 302 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 C 2 COMPLIMENT 86160 CPT 5000809 CDM 301 RC Facility Outpatient 186 93 135.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 73.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 74.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73 163 COMPLEMENT C2 86160 CPT 5000854 CDM 301 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 C4 COMPLIMENT 86160 CPT 5400090 CDM 302 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 52.47 52.47 52.47 1 through 10 Percent of Total Billed Charges 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.12 18.12 18.12 1 through 10 Percent of Total Billed Charges 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.12 43.56 56.58 1 through 10 Percent of Total Billed Charges 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 C3 NEPHRITIC FACTOR SERUM 86161 CPT 5000845 CDM 301 RC Facility Outpatient 193 96.5 140.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 169 COMPLEMENT TOTAL CH50 86162 CPT 5000309 CDM 302 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.32 40.48 42.32 1 through 10 Percent of Total Billed Charges 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 ECHO VIRUS SEROLOGY 86171 CPT 5000373 CDM 302 RC Facility Outpatient 215 107.5 156.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 189 CCP-CYCLIC CITCULLINATED PEPTIDE 86200 CPT 5000733 CDM 300 RC Facility Outpatient 105 52.5 73 55.65 55.65 55.65 1 through 10 Percent of Total Billed Charges 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 92 ANTI-DNASE TITERS 86215 CPT 5000808 CDM 301 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 ANTI-DNA DOUBLE STRAND 86225 CPT 5000034 CDM 302 RC Facility Outpatient 146 73 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 67.16 67.16 67.16 1 through 10 Percent of Total Billed Charges 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 128 ANTI-DNA DOUBLE STRAND 86225 CPT 5400038 CDM 302 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 67.16 67.16 67.16 1 through 10 Percent of Total Billed Charges 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 ANTI-DNA SINGLE STRANDED 86226 CPT 5000035 CDM 302 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 ANTI DNA SINGLE STRANDED 86226 CPT 5400039 CDM 302 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 ANTICENTROMERE AB 86235 CPT 5000255 CDM 302 RC Facility Outpatient 111 55.5 81.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 43.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 51.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 97 ANTI-SM AB 86235 CPT 5000256 CDM 302 RC Facility Outpatient 166 83 121.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 65.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 146 RNP 86235 CPT 5000555 CDM 302 RC Facility Outpatient 161 80.5 117.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 63.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 141 SJOGREN'S AB 86235 CPT 5000571 CDM 302 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 SM & RNP ANTIBODIES 86235 CPT 5000573 CDM 302 RC Facility Outpatient 154 77 112.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 60.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 135 ANTI-JO-1 86235 CPT 5000705 CDM 301 RC Facility Outpatient 128 64 93.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 50.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 112 DRUG SCREEN SAP9 86235 CPT 5000706 CDM 301 RC Facility Outpatient 58 29 42.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 22.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 51 AG SCREEN 1-10 86235 CPT 5000707 CDM 301 RC Facility Outpatient 155 77.5 113.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 61.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 136 ANTISCLERODERMA AB 86235 CPT 5000710 CDM 301 RC Facility Outpatient 384 192 280.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 151.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 337.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 307.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 291.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 176.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151 337 SCLERODERMA ANTIBODIES 86235 CPT 5000880 CDM 301 RC Facility Outpatient 207 103.5 151.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 89.57 89.57 1 through 10 Percent of Total Billed Charges 81.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 76.36 58.88 77.74 1 through 10 Percent of Total Billed Charges 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 182 ANTIPARIETAL CELL AB 86255 CPT 5000092 CDM 302 RC Facility Outpatient 95 47.5 69.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 37.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 43.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 83 ANCA 86255 CPT 5000137 CDM 302 RC Facility Outpatient 210 105 153.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 96.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82 184 ENDOMYOSIAL IGA 86255 CPT 5000141 CDM 302 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 RETICULIN AB 86255 CPT 5000143 CDM 302 RC Facility Outpatient 131 65.5 95.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 51.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 60.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 115 BB AUTOANTIBODY SCREEN 86255 CPT 5000265 CDM 302 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 MITOCHONDRIAL ANTIBODY SCREEN 86255 CPT 5000496 CDM 302 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 NEUTR CYTOPLASMIC AB 86255 CPT 5000506 CDM 302 RC Facility Outpatient 224 112 163.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 88.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 197 SKELETAL MUSCLE AB 86255 CPT 5000572 CDM 302 RC Facility Outpatient 56 28 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 SMOOTH MUSCLE ANTIBODY SCREEN 86255 CPT 5000574 CDM 302 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 STRIATIONAL AB 86255 CPT 5000711 CDM 301 RC Facility Outpatient 377 188.5 275.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 148.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 331.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 173.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148 331 ANITPARIETAL CELL AB 86255 CPT 5400089 CDM 302 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 111.3 111.3 111.3 1 through 10 Percent of Total Billed Charges 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92.4 92.4 92.4 1 through 10 Percent of Total Billed Charges 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 CA 27/29 86300 CPT 5000145 CDM 302 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 CA 19-9 CARBOHYDRATE AG 86301 CPT 5000280 CDM 302 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 CA 125 86304 CPT 5000279 CDM 302 RC Facility Outpatient 133 66.5 73 97.09 97.09 97.09 1 through 10 Percent of Total Billed Charges 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 MONO SCREEN 86308 CPT 5000498 CDM 302 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HETEROPHILE AB TITER 86309 CPT 5000430 CDM 302 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 CA 15-3 86316 CPT 5000284 CDM 302 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 CHROMOGRANIN 86316 CPT 5000810 CDM 301 RC Facility Outpatient 246 123 179.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 216 BARTONELLA HEMSLAE IGM AB 86317 CPT 5000268 CDM 302 RC Facility Outpatient 124 62 90.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 109 IMMUNO ELECTROPHORESIS 86320 CPT 5000461 CDM 302 RC Facility Outpatient 199 99.5 145.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 87.56 87.56 87.56 1 through 10 Percent of Total Billed Charges 91.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 175 TEICHOIC ACID 86329 CPT 5000044 CDM 301 RC Facility Outpatient 88 44 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 SERUM IMMUNFIXATION 86334 CPT 5000569 CDM 302 RC Facility Outpatient 244 122 178.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 112.24 38.18 112.24 1 through 10 Percent of Total Billed Charges 112.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 214 URINE IMMUNOFIXATION 86334 CPT 5000608 CDM 302 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 112.24 38.18 112.24 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 INSULIN ANTIBODIES 86337 CPT 5000464 CDM 302 RC Facility Outpatient 154 77 112.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 135 INTRINSIC FACTOR AB 86340 CPT 5000465 CDM 302 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 ISLET CELL ANTIBODY 86341 CPT 5000017 CDM 302 RC Facility Outpatient 129 64.5 94.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 113 ABSOLUTE T HELPER CELL CD4&CD8 COUNT 86360 CPT 5000163 CDM 302 RC Facility Outpatient 457 228.5 333.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 242.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 402.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 365.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 365.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180 402 THYROID MICROSOM AB 86376 CPT 5000587 CDM 302 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.76 49.76 49.76 1 through 10 Percent of Total Billed Charges 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 THYROID PEROXIDASE AB 86376 CPT 5000588 CDM 302 RC Facility Outpatient 120 60 87.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.76 49.76 49.76 1 through 10 Percent of Total Billed Charges 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 "LIVER KIDNEY MICRO Ab, IgG" 86376 CPT 5000885 CDM 301 RC Facility Outpatient 126 63 91.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.76 49.76 49.76 1 through 10 Percent of Total Billed Charges 52.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 MICROSOMAL ANTIBODY 86376 CPT 5400105 CDM 302 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 49.76 49.76 49.76 1 through 10 Percent of Total Billed Charges 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 BACTERIAL ANTIGEN PACKAGE 86403 CPT 5000266 CDM 302 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 RA LATEX 86430 CPT 5000544 CDM 302 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 RA TITER 86431 CPT 5000545 CDM 302 RC Facility Outpatient 92 46 73 48.76 48.76 48.76 1 through 10 Percent of Total Billed Charges 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 48.76 40.48 48.76 1 through 10 Percent of Total Billed Charges 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 QUANTIFERON 86480 CPT 5000859 CDM 301 RC Facility Outpatient 227 113.5 165.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89 199 "SKIN TEST, TUBERCULOSIS, INTRADERMAL" 86580 CPT 5000912 CDM 302 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 VDRL CSF 86592 CPT 5000083 CDM 302 RC Facility Outpatient 59 29.5 73 732.01 732.01 732.01 1 through 10 Percent of Total Billed Charges 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 441.21 16.28 441.21 1 through 10 Percent of Total Billed Charges 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 RPR 86592 CPT 5000558 CDM 302 RC Facility Outpatient 37 18.5 73 732.01 732.01 732.01 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 441.21 16.28 441.21 1 through 10 Percent of Total Billed Charges 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 VDRL BLOOD 86592 CPT 5400007 CDM 302 RC Facility Outpatient 8 4 73 732.01 732.01 732.01 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 441.21 16.28 441.21 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PREMARITAL RPR 86592 CPT 5400030 CDM 302 RC Facility Outpatient 8 4 73 732.01 732.01 732.01 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 441.21 16.28 441.21 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CSF VDRL 86592 CPT 5400080 CDM 302 RC Facility Outpatient 8 4 73 732.01 732.01 732.01 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 441.21 16.28 441.21 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RPR QUANTITATIVE 86593 CPT 5000829 CDM 302 RC Facility Outpatient 41 20.5 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 THERMOACTINOMYCES CANDIDUS AB 86602 CPT 5000134 CDM 302 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 THERMOACTINOMYCES SACCHARI AB 86602 CPT 5000135 CDM 302 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 THERMOACTINOMYCES VULGARIS AB 86602 CPT 5000136 CDM 302 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 ADENOVIRUS 86603 CPT 5000231 CDM 302 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 ASPERGILLUS SLAVUS AB 86606 CPT 5000127 CDM 302 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 ASPERGILLUS FUMIGATUS AB 86606 CPT 5000128 CDM 302 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 ASPERGILLUS NIGER AB 86606 CPT 5000129 CDM 302 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 PNEUMOCOCCAL ANTIBODY TITER 86609 CPT 5000003 CDM 301 RC Facility Outpatient 362 181 264.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 318.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 275.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142 318 SACCAROMONOSPORA VIRIDUS 86609 CPT 5000133 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 HOMAD EHRLICHIOSIS TITER 86609 CPT 5000437 CDM 302 RC Facility Outpatient 232 116 169.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 204 RICKETTSIAL IGG/IGM 86609 CPT 5000553 CDM 302 RC Facility Outpatient 61 30.5 44.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 53 CAT SCRATCH FEVER-B HENSELAE IgG 86611 CPT 5000165 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 CAT SCRATCH FEVER-B HENSELAE IgM 86611 CPT 5000166 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 CAT SCRATCH FEVER-B QUINTANA IgG 86611 CPT 5000167 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 CAT SCRATCH FEVER-B QUINTANA IgM 86611 CPT 5000168 CDM 301 RC Facility Outpatient 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 BORDETELLA PERTUSSIS ANTI-BODIES 86615 CPT 5000837 CDM 301 RC Facility Outpatient 493 246.5 359.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 433.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194 433 BORDETELLA PERTUSSIS ANTI-BODIES 86615 CPT 5000838 CDM 301 RC Facility Outpatient 493 246.5 359.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 433.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194 433 "LYME, TOTAL AB WB CONFIRMATION" 86618 CPT 5000486 CDM 302 RC Facility Outpatient 161 80.5 117.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 141 LYME IGG 86618 CPT 5000487 CDM 302 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 LYME IGM 86618 CPT 5000488 CDM 302 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 LYME DISEASE DNR 86618 CPT 5400014 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 LYME LGG TITER 86618 CPT 5400068 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 BRUCELLA AB 86622 CPT 5000277 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 CHLAMYDIA AB 86631 CPT 5000010 CDM 302 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 CHLAMYDIA AB 86631 CPT 5400004 CDM 302 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 CHLAMYDIA IGM 86632 CPT 5000292 CDM 302 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 COCCIDIOIDES ANTIBODY 86635 CPT 5000305 CDM 302 RC Facility Outpatient 285 142.5 208.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 228 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 250 CMV 86644 CPT 5000301 CDM 302 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 CMV IGG AB 86644 CPT 5000302 CDM 302 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 CMV IGM AB 86645 CPT 5000303 CDM 302 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 DIPHTHERIA ANTIBODY TITER 86648 CPT 5000004 CDM 301 RC Facility Outpatient 359 179.5 73 262.07 262.07 262.07 1 through 10 Percent of Total Billed Charges 165.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 315.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141 315 ENCEPHALITIS CALIFORNIA (LA CROSSE) 86651 CPT 5000376 CDM 302 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 ENCEPHALITIS EASTERN EQUINE 86652 CPT 5000377 CDM 302 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 ENCEPHALITIS ST LOUIS 86653 CPT 5000379 CDM 302 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 ENCEPHALITIS WESTERN EQUINE 86654 CPT 5000380 CDM 302 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 COXSACKIE B 86658 CPT 5000314 CDM 302 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 ECHOVIRUS AB 86658 CPT 5000374 CDM 302 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 EPSTEIN BARR- AB 86663 CPT 5400061 CDM 302 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 EPSTEIN BARR-AB 86664 CPT 5000061 CDM 302 RC Facility Outpatient 161 80.5 117.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 141 EBV-IGM 86665 CPT 5000732 CDM 300 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 EBV-IGG 86665 CPT 5000736 CDM 300 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 EHRLICHIA ANTIBODY 86666 CPT 5000750 CDM 302 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 AUREOBASIDIUM PULLULANS AB 86671 CPT 5000130 CDM 302 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 MICROPOLYSPORA RECTICIRGULA AB 86671 CPT 5000131 CDM 302 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 SACCHAROMYSIS PROFILE 86671 CPT 5000848 CDM 301 RC Facility Outpatient 261 130.5 190.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 208.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102 229 H PYLORI AB IGG 86677 CPT 5000411 CDM 302 RC Facility Outpatient 40 20 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 H PYLORI AB IGM 86677 CPT 5000658 CDM 302 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 H PYLORI AB IGA 86677 CPT 5000659 CDM 302 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 HIV SCREEN 86687 CPT 5000435 CDM 302 RC Facility Outpatient 106 53 77.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.18 46.64 56.18 1 through 10 Percent of Total Billed Charges 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 93 HUMAN T-CELL LYPHOCYTE VIRUS 86687 CPT 5000439 CDM 302 RC Facility Outpatient 163 81.5 118.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 56.18 46.64 56.18 1 through 10 Percent of Total Billed Charges 74.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 143 WESTERN BLOT HIV 86689 CPT 5000624 CDM 302 RC Facility Outpatient 222 111 162.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 195 HEP DELTA VIRUS AB 86692 CPT 5000427 CDM 302 RC Facility Outpatient 57 28.5 41.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 HERPES SIMP I - ICG 86695 CPT 5000428 CDM 302 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 HERPES SIMP I - IGM 86695 CPT 5000701 CDM 301 RC Facility Outpatient 94 47 68.62 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 82 HERPES SIMP II IGM 86696 CPT 5000429 CDM 302 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 HISTOPLASMA AB 86698 CPT 5000434 CDM 302 RC Facility Outpatient 100 50 73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 HIV 2 86702 CPT 5000830 CDM 302 RC Facility Outpatient 220 110 160.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 193 HBCAB - HEP B CORE AB 86704 CPT 5000416 CDM 302 RC Facility Outpatient 87 43.5 63.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 76 HEP B CORE AB IGM 86705 CPT 5000147 CDM 302 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 24.38 24.38 24.38 1 through 10 Percent of Total Billed Charges 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.16 21.16 21.16 1 through 10 Percent of Total Billed Charges 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 HBSAB 86706 CPT 5000419 CDM 302 RC Facility Outpatient 80 40 58.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 42.4 42.4 42.4 1 through 10 Percent of Total Billed Charges 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 35.2 35.2 35.2 1 through 10 Percent of Total Billed Charges 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 HBEAB - HEP BE AB 86707 CPT 5000417 CDM 302 RC Facility Outpatient 79 39.5 57.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 69 HAAB - HEP A AB 86708 CPT 5000412 CDM 302 RC Facility Outpatient 86 43 62.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 75 HEP A IgM ANTIBODY 86709 CPT 5000120 CDM 301 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HAAB - IGM 86709 CPT 5000413 CDM 302 RC Facility Outpatient 46 23 33.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 40 INFLUENZA 86710 CPT 5400106 CDM 302 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 LEGIONELLA AB EVAL 86713 CPT 5000472 CDM 302 RC Facility Outpatient 192 96 140.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 168 LEGIONELLA AB PANEL 86713 CPT 5000473 CDM 302 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 LEGIONELLA ANTIBODIES 86713 CPT 5000474 CDM 302 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 MUMPS - IGA 86735 CPT 5000074 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 127 MUMPS - IGM 86735 CPT 5000700 CDM 301 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 MMR 86735 CPT 5000902 CDM 302 RC Facility Outpatient 253 126.5 184.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99 222 VARICELLA 86735 CPT 5000903 CDM 302 RC Facility Outpatient 89 44.5 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 MYCO PNEU IGG IGM AB 86738 CPT 5000064 CDM 302 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 MYCOPL PNEUM IGG AB 86738 CPT 5000499 CDM 302 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 MYCOPLASMA AB TWAR 86738 CPT 5000500 CDM 302 RC Facility Outpatient 365 182.5 266.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 321.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 292 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 292 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 277.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143 321 MYCO PNEU IGG IGM AB 86738 CPT 5400065 CDM 302 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 PARVOVIRUS ANTIBODY 86747 CPT 5000176 CDM 301 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 AMOEBA ANTIBODY 86753 CPT 5000246 CDM 302 RC Facility Outpatient 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 RSV ANTIBODY 86756 CPT 5000559 CDM 302 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 ROTAVIRUS 86759 CPT 5000557 CDM 302 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 MEASLES AB 86762 CPT 5000490 CDM 302 RC Facility Outpatient 277 138.5 202.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 243.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109 243 RUBELLA SCREEN 86762 CPT 5000560 CDM 302 RC Facility Outpatient 79 39.5 57.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 69 TORCH TITER 86765 CPT 5000593 CDM 302 RC Facility Outpatient 162 81 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 SARS CORONAVIRUS 2 IGG+IGM AB 86769 CPT 5000899 CDM 301 RC Facility Outpatient 50 25 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 TETANUS ANTIBODY TITER 86774 CPT 5000002 CDM 301 RC Facility Outpatient 270 135 197.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 216 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 237 TOXOPLASMA 86777 CPT 5000595 CDM 302 RC Facility Outpatient 336 168 245.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 295.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 295 TOXOPLASMA TITER EIA 86777 CPT 5000597 CDM 302 RC Facility Outpatient 87 43.5 63.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 76 TOXOPLASMA IGM 86778 CPT 5000596 CDM 302 RC Facility Outpatient 94 47 68.62 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 82 TREPONEMA PALLIDUM SYPHILIS SCREEN 86780 CPT 5000400 CDM 302 RC Facility Outpatient 71 35.5 51.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 62 VARICELLA ZOSTER VIRUS 86787 CPT 5000069 CDM 301 RC Facility Outpatient 145 72.5 105.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 127 HERPES SIMPLEX VIRUS TYPE 2 IgG ANTI 86790 CPT 5000066 CDM 301 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 WEST NILE FEVER CSF ANTIBODY 86790 CPT 5000152 CDM 301 RC Facility Outpatient 254 127 185.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 223.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 223 WEST NILE FEVER SERUM ANTIBODY 86790 CPT 5000153 CDM 301 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 209 DENGUE FEVER ANTIBODIES 86790 CPT 5000673 CDM 302 RC Facility Outpatient 224 112 163.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 197 THYROGLOBULIN AB 86800 CPT 5000110 CDM 302 RC Facility Outpatient 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 17.41 17.41 17.41 1 through 10 Percent of Total Billed Charges 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.32 19.32 19.32 1 through 10 Percent of Total Billed Charges 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 THYROID ANTIBODIES 86800 CPT 5000586 CDM 302 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 17.41 17.41 17.41 1 through 10 Percent of Total Billed Charges 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.32 19.32 19.32 1 through 10 Percent of Total Billed Charges 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 THYROCLOBULIN AB 86800 CPT 5400110 CDM 302 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 17.41 17.41 17.41 1 through 10 Percent of Total Billed Charges 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 19.32 19.32 19.32 1 through 10 Percent of Total Billed Charges 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 HEP C ANTIBODY 86803 CPT 5000122 CDM 301 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.5 33 39.75 1 through 10 Percent of Total Billed Charges 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HC AB HEP C AB 86803 CPT 5000421 CDM 302 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.5 33 39.75 1 through 10 Percent of Total Billed Charges 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 HLA-B27 86812 CPT 5000436 CDM 302 RC Facility Outpatient 177 88.5 129.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 155 PIGEON SERUM AB 86849 CPT 5000132 CDM 302 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 BB AB SCREEN 86850 CPT 5600025 CDM 302 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 169 169 169 1 through 10 Percent of Total Billed Charges 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 74.36 89.57 1 through 10 Percent of Total Billed Charges 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 "TREPONEMA ANTIBODIES, FLUOR, ABSORB (FTA" 86850 CPT 5600044 CDM 305 RC Facility Outpatient 50 25 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 169 169 169 1 through 10 Percent of Total Billed Charges 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.57 74.36 89.57 1 through 10 Percent of Total Billed Charges 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 BB ELUTION 86860 CPT 5600019 CDM 302 RC Facility Outpatient 189 94.5 137.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 166 BB RBC AB ID 86870 CPT 5000548 CDM 300 RC Facility Outpatient 445.68 222.84 325.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 BB AB PANEL 86870 CPT 5600003 CDM 302 RC Facility Outpatient 445.68 222.84 325.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 BB DAT 86880 CPT 5000361 CDM 302 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 DIRECT ANTIGLOBULIN (COOMBS) TEST 86880 CPT 5600023 CDM 302 RC Facility Outpatient 78 39 56.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 68 BB COOMBS TEST-DIRECT 86880 CPT 5600027 CDM 302 RC Facility Outpatient 67 33.5 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 INDIRECT ANTIBODY COOMBS TEST 86885 CPT 5600021 CDM 302 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 BB INDIRECT COOMBS 86885 CPT 5600032 CDM 302 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 RBC ANTIBODY DETECTION TEST 86885 CPT 5600045 CDM 305 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 INDIRECT TITER 86886 CPT 5600033 CDM 302 RC Facility Outpatient 125 62.5 91.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 BLOOD TYPING; ABG 86900 CPT 5400114 CDM 302 RC Facility Outpatient 6 3 4.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119.05 119.05 119.05 1 through 10 Percent of Total Billed Charges 2.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 104.76 63.1 126.19 1 through 10 Percent of Total Billed Charges 2.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 5 BB ABO GROUP 86900 CPT 5600030 CDM 302 RC Facility Outpatient 119.05 59.52 86.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119.05 119.05 119.05 1 through 10 Percent of Total Billed Charges 47.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 104.76 63.1 126.19 1 through 10 Percent of Total Billed Charges 54.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 104 GRP 1 SCRN TEST FOR COMPAT BLOOD UNIT 86900 CPT 5600046 CDM 309 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119.05 119.05 119.05 1 through 10 Percent of Total Billed Charges 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 104.76 63.1 126.19 1 through 10 Percent of Total Billed Charges 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 BB RH 86901 CPT 5600026 CDM 302 RC Facility Outpatient 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 39 39 39 1 through 10 Percent of Total Billed Charges 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 20.67 17.16 20.67 1 through 10 Percent of Total Billed Charges 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 GRP 2 SCRN TEST FOR COMPAT BLOOD UNIT 86902 CPT 5600047 CDM 309 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 GRP 3 SCRN TEST FOR COMPAT BLOOD UNIT 86902 CPT 5600048 CDM 309 RC Facility Outpatient 65 32.5 47.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 GRP 4 SCRN TEST FOR COMPAT BLOOD UNIT 86902 CPT 5600049 CDM 309 RC Facility Outpatient 130 65 94.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 114 COMPATIBILITY SCREEN 86904 CPT 5600031 CDM 302 RC Facility Outpatient 99 49.5 72.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 87 BB RBC AG TYPING SCRN 86905 CPT 5600039 CDM 302 RC Facility Outpatient 607 303.5 443.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 321.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 251.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 534.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 485.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 243.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 485.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239 534 BB RBC PHENOTYPE 86905 CPT 5600040 CDM 302 RC Facility Outpatient 219.25 109.62 160.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.94 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.63 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BB RH PHENOTYPE 86906 CPT 5600001 CDM 302 RC Facility Outpatient 74 37 54.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 65 BB CROSSMATCH IMMED SPIN 86920 CPT 5600029 CDM 302 RC Facility Outpatient 135 67.5 98.55 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.55 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 135 135 135 1 through 10 Percent of Total Billed Charges 54.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 143.1 118.8 143.1 1 through 10 Percent of Total Billed Charges 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 118 BB XM INCUBATION 86921 CPT 5600002 CDM 302 RC Facility Outpatient 219.25 109.62 160.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.94 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.63 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BB INCUBATION 86921 CPT 5600018 CDM 302 RC Facility Outpatient 219.25 109.62 160.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.94 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.63 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 BB CROSSMATCH AHG TECHNIQUE 86922 CPT 5600028 CDM 302 RC Facility Outpatient 224 112 163.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 197 BB FROZEN BLOOD THAW 86931 CPT 5600053 CDM 305 RC Facility Outpatient 516 258 376.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 273.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 454.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 412.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 412.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203 454 BB AGGLUT&HEMOLYSINS SCREEN 86940 CPT 5600024 CDM 302 RC Facility Outpatient 89 44.5 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 BB INCUBATED AGG/HEMOLYSIS SCRN 86941 CPT 5600020 CDM 302 RC Facility Outpatient 176 88 128.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 154 BB PLATELET POOLING 86965 CPT 5600005 CDM 302 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 BB RBC PRETREAT W/CHEM DRUG 86970 CPT 5600038 CDM 302 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 BB RBC PRETREAT W/ENZYMES 86971 CPT 5600036 CDM 302 RC Facility Outpatient 219.25 109.62 160.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.94 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.63 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86 192 PRE-TRTMENT OF SERUM W/CHEMICAL/DRUG 86975 CPT 5600037 CDM 302 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 DILUTION OF SERUM 86976 CPT 5600017 CDM 302 RC Facility Outpatient 41 20.5 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 INHIBITION OF SERUM 86977 CPT 5600034 CDM 302 RC Facility Outpatient 123 61.5 89.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 BB RBC ABSOPTION 86978 CPT 5000177 CDM 302 RC Facility Outpatient 63 31.5 45.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 55 CRYPTOSPORIDIUM STOOL 87015 CPT 5000325 CDM 306 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 CULTURE BLOOD 87040 CPT 5000329 CDM 306 RC Facility Outpatient 146 73 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 154.76 77.38 154.76 1 through 10 Percent of Total Billed Charges 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 14.09 14.09 14.09 1 through 10 Percent of Total Billed Charges 53 140.8 60.55 140.8 1 through 10 Percent of Total Billed Charges 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 146 146 146 1 through 10 Percent of Total Billed Charges 53.13 9.97 100 1 through 10 Percent of Total Billed Charges 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 128.48 67.16 128.48 1 through 10 Percent of Total Billed Charges 53 128.48 64.24 154.76 16 Percent of Total Billed Charges 53 62.58 62.58 62.58 1 through 10 Percent of Total Billed Charges 57 128 CULTURE BLOOD ARD 87040 CPT 5000330 CDM 306 RC Facility Outpatient 183 91.5 133.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 154.76 77.38 154.76 1 through 10 Percent of Total Billed Charges 72.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 14.09 14.09 14.09 1 through 10 Percent of Total Billed Charges 53 140.8 60.55 140.8 1 through 10 Percent of Total Billed Charges 75.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 146 146 146 1 through 10 Percent of Total Billed Charges 53.13 9.97 100 1 through 10 Percent of Total Billed Charges 146.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 128.48 67.16 128.48 1 through 10 Percent of Total Billed Charges 53 128.48 64.24 154.76 16 Percent of Total Billed Charges 53 62.58 62.58 62.58 1 through 10 Percent of Total Billed Charges 72 161 CULTURE STOOL 87045 CPT 5000346 CDM 306 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 57.64 57.64 57.64 1 through 10 Percent of Total Billed Charges 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 CULTURE YERSINIA 87046 CPT 5000353 CDM 306 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 CATHETER TIP CULTURE 87070 CPT 5000287 CDM 306 RC Facility Outpatient 118 59 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 46 94 CULTURE BODY FLUID 87070 CPT 5000332 CDM 306 RC Facility Outpatient 124 62 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 48.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 48 99 CULTURE CERVICAL/PENILE 87070 CPT 5000334 CDM 306 RC Facility Outpatient 132 66 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 52 105 CULTURE CSF 87070 CPT 5000336 CDM 306 RC Facility Outpatient 133 66.5 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 52 106 CULTURE EYE 87070 CPT 5000337 CDM 306 RC Facility Outpatient 129 64.5 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 50 103 CULTURE NON-STANDARD 87070 CPT 5000343 CDM 306 RC Facility Outpatient 44 22 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 17 35 CULTURE NOSE 87070 CPT 5000344 CDM 306 RC Facility Outpatient 115 57.5 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 45 92 CULTURE SPUTUM 87070 CPT 5000345 CDM 306 RC Facility Outpatient 132 66 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 52 105 CULTURE THROAT 87070 CPT 5000347 CDM 306 RC Facility Outpatient 102 51 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 40 81 CULTURE TISSUE 87070 CPT 5000348 CDM 306 RC Facility Outpatient 122 61 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 48.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 48 97 CULTURE VAGINAL 87070 CPT 5000350 CDM 306 RC Facility Outpatient 25 12.5 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 9 20 CULTURE AEROBIC 87070 CPT 5000352 CDM 306 RC Facility Outpatient 132 66 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 52.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 105.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 52 105 CULTURE AEROBIC/ANEROBIC 87070 CPT 5000905 CDM 306 RC Facility Outpatient 294 147 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 115.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 235.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 235.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 115 235 CULTURE ENVIRONMENTAL 87070 CPT 5400002 CDM 306 RC Facility Outpatient 15 7.5 73 74.46 45.9 214.62 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 54.06 1 through 10 Percent of Total Billed Charges 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 82.18 42.3 82.18 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 9.05 9.05 9.05 24 Percent of Total Billed Charges 88 85.78 85.78 85.78 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 69.28 6.8 129.36 1 through 10 Percent of Total Billed Charges 100 100 100 23 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 54.06 54.06 86.7 1 through 10 Percent of Total Billed Charges 53 46.92 44.88 69.96 40 Percent of Total Billed Charges 53 43.71 43.71 43.71 1 through 10 Percent of Total Billed Charges 5 12 CULTURE ANAEROBIC 87075 CPT 5000328 CDM 306 RC Facility Outpatient 162 81 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 ID ORGANISM - 2 ANAEROBIC 87076 CPT 5000443 CDM 306 RC Facility Outpatient 130 65 94.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 114 ID ORGANISM - ANAEROBIC 87076 CPT 5000450 CDM 306 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 ID ORGANISM - 2 AEROBIC 87077 CPT 5000442 CDM 306 RC Facility Outpatient 61 30.5 44.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 53 ID ORGANISM - AEROBIC 87077 CPT 5000451 CDM 306 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 CULTURE CAMPYLOBACTER 87081 CPT 5000333 CDM 306 RC Facility Outpatient 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 CULTURE GC 87081 CPT 5000340 CDM 306 RC Facility Outpatient 56 28 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 CULTURE LEGIONELLA 87081 CPT 5000342 CDM 306 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 MRSA SCREEN 87081 CPT 5000695 CDM 301 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 CULTURE URINE 87088 CPT 5000349 CDM 306 RC Facility Outpatient 92 46 73 67.16 48.76 67.16 1 through 10 Percent of Total Billed Charges 53 48.76 48.76 48.76 1 through 10 Percent of Total Billed Charges 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.15 11.05 38.15 1 through 10 Percent of Total Billed Charges 53 38.15 38.15 38.15 1 through 10 Percent of Total Billed Charges 8.49 8.49 8.49 1 through 10 Percent of Total Billed Charges 88 77.37 46 77.37 1 through 10 Percent of Total Billed Charges 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92 63.36 92 1 through 10 Percent of Total Billed Charges 100 10.86 100 1 through 10 Percent of Total Billed Charges 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 42.32 40.48 78.2 1 through 10 Percent of Total Billed Charges 53 42.32 40.48 48.76 57 Percent of Total Billed Charges 53 38.15 38.15 39.43 1 through 10 Percent of Total Billed Charges 36 73 ID ORGANISM - URINE 87088 CPT 5000454 CDM 306 RC Facility Outpatient 30 15 73 67.16 48.76 67.16 1 through 10 Percent of Total Billed Charges 53 48.76 48.76 48.76 1 through 10 Percent of Total Billed Charges 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 38.15 11.05 38.15 1 through 10 Percent of Total Billed Charges 53 38.15 38.15 38.15 1 through 10 Percent of Total Billed Charges 8.49 8.49 8.49 1 through 10 Percent of Total Billed Charges 88 77.37 46 77.37 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 92 63.36 92 1 through 10 Percent of Total Billed Charges 100 10.86 100 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 42.32 40.48 78.2 1 through 10 Percent of Total Billed Charges 53 42.32 40.48 48.76 57 Percent of Total Billed Charges 53 38.15 38.15 39.43 1 through 10 Percent of Total Billed Charges 11 24 CULTURE FUNGUS SKIN 87101 CPT 5000339 CDM 306 RC Facility Outpatient 128 64 93.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 112 CULTURE FUNGUS OTHER 87102 CPT 5000338 CDM 306 RC Facility Outpatient 168 84 122.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 147 ID ORGANISM - FUNGUS 87106 CPT 5000452 CDM 306 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 CULTURE MYCOPLASMA PNEUMO 87109 CPT 5000100 CDM 306 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 CULTURE MYCOPL DNEUM 87109 CPT 5400098 CDM 306 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 CULTURE CHLAMYDIA 87110 CPT 5000335 CDM 306 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 CULTURE AFB (INCLUDES AFB STAIN) 87116 CPT 5000327 CDM 306 RC Facility Outpatient 143 71.5 104.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 125 CULTURE BLOOD MYCOBACTERIUM 87118 CPT 5000331 CDM 306 RC Facility Outpatient 189 94.5 137.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 166 ID ORGANISM - MYCOBACTERIA 87118 CPT 5000453 CDM 306 RC Facility Outpatient 48 24 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 42 OVA AND PARASITES 87177 CPT 5000515 CDM 306 RC Facility Outpatient 77 38.5 56.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 31.94 31.94 31.94 1 through 10 Percent of Total Billed Charges 31.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 67 SENSITIVITY ANTIBIOTIC 87186 CPT 5000564 CDM 306 RC Facility Outpatient 98 49 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 SENSITIVITY - TROVAN 87187 CPT 5000118 CDM 306 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 FECAL WBC 87205 CPT 5000390 CDM 306 RC Facility Outpatient 77 38.5 56.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 67 GRAM STN 87205 CPT 5000410 CDM 306 RC Facility Outpatient 56 28 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 EOSINOPHIL URINE 87205 CPT 5000866 CDM 301 RC Facility Outpatient 400 200 292 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 304 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157 352 AFB STAIN (SMEAR)ONLY 87206 CPT 5000108 CDM 306 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 FUNGAL SMEAR 87206 CPT 5000401 CDM 306 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 AFB STAIN (SMEAR) ONLY 87206 CPT 5400107 CDM 306 RC Facility Outpatient 10 5 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 MALARIA SMEAR 87207 CPT 5000489 CDM 306 RC Facility Outpatient 139 69.5 101.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54 122 INDIA INK PREP 87210 CPT 5000462 CDM 306 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 5.63 5.63 1 through 10 Percent of Total Billed Charges 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 WET PREP 87210 CPT 5000625 CDM 306 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 5.63 5.63 1 through 10 Percent of Total Billed Charges 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 KOH PREP 87220 CPT 5000468 CDM 306 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 CULTURE HERPES 87252 CPT 5000341 CDM 306 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 CULTURE VIRAL 87252 CPT 5000351 CDM 306 RC Facility Outpatient 305 152.5 222.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 268 BORDETELLA PERTUSSIS - NASOP CULTURE 87265 CPT 5000712 CDM 301 RC Facility Outpatient 122 61 89.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 107 LEGIONELLA DFA 87278 CPT 5000475 CDM 306 RC Facility Outpatient 231 115.5 168.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 203 PNEUMOCYSTIS 87281 CPT 5200032 CDM 312 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 C DIFFICILE TOXIN A & B 87324 CPT 5000278 CDM 306 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 99 CRYPTOCOCCAL ANTIGEN 87327 CPT 5000324 CDM 306 RC Facility Outpatient 189 94.5 137.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 166 GIARDIA ANTIGEN (STOOL) 87328 CPT 5000406 CDM 306 RC Facility Outpatient 171 85.5 124.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67 150 H PYLORI STOOL ANTIGEN 87338 CPT 5000142 CDM 306 RC Facility Outpatient 323 161.5 235.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 245.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127 284 HEP B SURFACE AG 87340 CPT 5000121 CDM 301 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 39.75 39.75 39.75 1 through 10 Percent of Total Billed Charges 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 33 33 33 1 through 10 Percent of Total Billed Charges 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HEP B SURFACE AG 87340 CPT 5000420 CDM 306 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 39.75 39.75 39.75 1 through 10 Percent of Total Billed Charges 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 33 33 33 1 through 10 Percent of Total Billed Charges 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 HBEAG - HEP BE AG 87350 CPT 5000418 CDM 306 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 HIV 1&2 QUALITATIVE RNA 87389 CPT 5000904 CDM 302 RC Facility Outpatient 396 198 289.08 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 209.88 209.88 209.88 1 through 10 Percent of Total Billed Charges 156.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.88 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 348.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 348 RSV CULTURE 87420 CPT 5000124 CDM 306 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 SARS-CoV-2 ANTIGEN 87426 CPT 5000900 CDM 306 RC Facility Outpatient 200 100 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.46 49.46 49.46 1 through 10 Percent of Total Billed Charges 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 87.09 100 1 through 10 Percent of Total Billed Charges 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 STREP SCREEN THROAT 87430 CPT 5000578 CDM 306 RC Facility Outpatient 68 34 73 49.64 30.61 49.64 1 through 10 Percent of Total Billed Charges 53 36.04 36.04 36.04 1 through 10 Percent of Total Billed Charges 26.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 54.79 28.2 54.79 1 through 10 Percent of Total Billed Charges 53 28.2 28.2 28.2 1 through 10 Percent of Total Billed Charges 15.83 15.83 15.83 30 Percent of Total Billed Charges 88 57.19 57.19 57.19 1 through 10 Percent of Total Billed Charges 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 68 68 68 1 through 10 Percent of Total Billed Charges 100 15.38 100 38 Percent of Total Billed Charges 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 36.04 29.92 57.8 1 through 10 Percent of Total Billed Charges 53 31.28 29.92 36.04 42 Percent of Total Billed Charges 53 29.15 29.15 29.15 1 through 10 Percent of Total Billed Charges 26 54 CHLAMYDIA DNA PROBE 87490 CPT 5000291 CDM 306 RC Facility Outpatient 113 56.5 82.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.89 23.89 23.89 1 through 10 Percent of Total Billed Charges 99.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 99 CHLAMYDIA PROBE URINE 87491 CPT 5000742 CDM 306 RC Facility Outpatient 90 45 73 418.51 418.51 418.51 1 through 10 Percent of Total Billed Charges 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 CMV BY PCR 87496 CPT 5000868 CDM 301 RC Facility Outpatient 357 178.5 260.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 314.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 271.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140 314 HEP B DNA QUANT 87517 CPT 5000745 CDM 300 RC Facility Outpatient 673 336.5 491.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 592.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 538.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 270.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 538.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265 592 HEP C QUANT VIRAL PANEL 87521 CPT 5000162 CDM 301 RC Facility Outpatient 288 144 210.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113 253 HEPATITIS C VIRUS RNA PCR 87521 CPT 5000870 CDM 301 RC Facility Outpatient 417 208.5 304.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 366.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 366 HEP C VIRUS QUANTITATIVE 87522 CPT 5000055 CDM 301 RC Facility Outpatient 802 401 585.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 315.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 331.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 705.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 641.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 322.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 641.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 609.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 315 705 HIV RNA QUANTITATIVE LEVEL 87536 CPT 5000161 CDM 301 RC Facility Outpatient 493 246.5 359.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 433.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 394.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194 433 RNA REAL TIME PCR (GRAPH) 87536 CPT 5000744 CDM 301 RC Facility Outpatient 506 253 369.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 445.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 404.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 384.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 232.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199 445 LEGIONELLA DNA PROBE 87540 CPT 5000476 CDM 306 RC Facility Outpatient 213 106.5 155.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 187 GC DNA PROBE 87590 CPT 5000404 CDM 306 RC Facility Outpatient 136 68 99.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119 GC PROBE URINE 87591 CPT 5000743 CDM 306 RC Facility Outpatient 90 45 65.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 79 INFECTIOUS AGENT DETECTION BY DNA OR RNA 87593 CPT 5000906 CDM 306 RC Facility Outpatient 124.7 62.35 91.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.74 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.76 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.77 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 109 INFECT AGENT DETECTION OF NUCLEIC ACID 87661 CPT 5000913 CDM 302 RC Facility Outpatient 169 84.5 123.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 148 VARICELLA PCR 87798 CPT 5000860 CDM 301 RC Facility Outpatient 489 244.5 356.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 430.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 391.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 391.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 371.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192 430 NOROVIRUS 87798 CPT 5087798 CDM 301 RC Facility Outpatient 348 174 254.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 306.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137 306 INFLUENZA A & B ANTIGEN 87804 CPT 5000657 CDM 302 RC Facility Outpatient 258 129 188.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.17 174.17 174.17 1 through 10 Percent of Total Billed Charges 227.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.34 100 112.34 1 through 10 Percent of Total Billed Charges 206.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101 227 GENOSURE VIRAL PANEL 87901 CPT 5000160 CDM 301 RC Facility Outpatient 560 280 408.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 492.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 448 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 225.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 448 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220 492 CYTOLOGY URINE 88104 CPT 5200025 CDM 311 RC Facility Outpatient 41 20.5 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 SPUTUM CYTOLOGY 88108 CPT 5200024 CDM 311 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 CONCENTRATION 88108 CPT 5200027 CDM 312 RC Facility Outpatient 44 22 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 NGYN THIN PREP 88161 CPT 5200028 CDM 312 RC Facility Outpatient 86 43 62.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 75 CYT QUICK STAIN FNA 88172 CPT 5200009 CDM 311 RC Facility Outpatient 217.5 108.75 158.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.3 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 FINE NEEDLE ASPIRATION 88172 CPT 5200023 CDM 311 RC Facility Outpatient 217.5 108.75 158.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.3 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.05 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85 191 FINE NEEDLE ASPIRATE 88173 CPT 5200029 CDM 312 RC Facility Outpatient 75 37.5 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 DNA CELL CYCLE 88182 CPT 5200002 CDM 311 RC Facility Outpatient 345 172.5 251.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 303.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 303 T-HELPER CD4 88182 CPT 5200008 CDM 311 RC Facility Outpatient 167 83.5 121.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 146 CD4 / CD8 LYMPHOCYTES 88182 CPT 5200011 CDM 311 RC Facility Outpatient 501 250.5 365.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 440.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197 440 T-CELL PANEL 88182 CPT 5200012 CDM 311 RC Facility Outpatient 141 70.5 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 TISSUE CULTURE BONE MARROWCELL 88237 CPT 5000591 CDM 311 RC Facility Outpatient 644 322 470.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 341.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 266.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 566.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 515.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 515.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 489.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253 566 CHROMOSOME ANALYSIS 15-20 CELL 88262 CPT 5000296 CDM 311 RC Facility Outpatient 644 322 470.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 341.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 266.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 566.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 515.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 515.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 489.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253 566 GROSS EXAM ONLY 88300 CPT 5200030 CDM 312 RC Facility Outpatient 64.93 32.46 47.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.14 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.35 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 SURG L-I PATH GROSS & MICROSCOPIC 88300 CPT 5200031 CDM 312 RC Facility Outpatient 64.93 32.46 47.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.14 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.35 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.87 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 SURG L-II PATH GROSS & MICROSCOPIC 88302 CPT 5200042 CDM 312 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 SURG L-III PATH GROSS & MICROSCOPIC 88304 CPT 5200041 CDM 312 RC Facility Outpatient 62 31 45.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 54 SURG L-IV PATH GROSS & MICROSCOPIC 88305 CPT 5200038 CDM 312 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 CELL BLOCK 88305 CPT 5200039 CDM 312 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 SURG PATH GROSS & MISCROSCOPIC EXAM 88307 CPT 5200021 CDM 312 RC Facility Outpatient 445.68 222.84 325.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 SURG L-V PATH GROSS & MICROSCOPIC 88307 CPT 5200043 CDM 312 RC Facility Outpatient 445.68 222.84 325.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.54 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.01 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 SURG L-VI PATH GROSS & MICROSCOPIC 88309 CPT 5200037 CDM 312 RC Facility Outpatient 937.53 468.76 684.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 496.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 825.03 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 712.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369 825 DECALCIFICATION 88311 CPT 5200036 CDM 312 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 STAIN HELICOBACTER 88312 CPT 5200001 CDM 312 RC Facility Outpatient 937.53 468.76 684.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 496.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 825.03 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 712.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369 825 STAIN GIEMSA PNEUMOCYSTIS 88312 CPT 5200013 CDM 312 RC Facility Outpatient 937.53 468.76 684.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 496.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 825.03 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 712.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369 825 STAIN HELICOBACTER 88312 CPT 5200026 CDM 312 RC Facility Outpatient 937.53 468.76 684.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 496.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 825.03 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 750.02 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 712.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 431.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369 825 STAIN IRON 88313 CPT 5200033 CDM 312 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 STAIN GIEMSA 88313 CPT 5200034 CDM 312 RC Facility Outpatient 29 14.5 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 FROZEN SECTIONS 88331 CPT 5200007 CDM 312 RC Facility Outpatient 135 67.5 98.55 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.55 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 118 NMO-IGG 88347 CPT 5000662 CDM 301 RC Facility Outpatient 877 438.5 640.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 464.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 362.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 771.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 352.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 701.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 666.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345 771 CSF CELL CT - NO DIFF 89050 CPT 5000079 CDM 305 RC Facility Outpatient 92 46 67.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 CELL COUNT/BODY FLUIDS 89050 CPT 5000289 CDM 305 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 CSF CELL CT - NO DIF 89050 CPT 5400076 CDM 300 RC Facility Outpatient 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CSF CELL COUNT DIFF 89051 CPT 5000326 CDM 305 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 CRYSTALS SYNO FL+ INT 89060 CPT 5000051 CDM 301 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 "CRYSTALS,CELL CT FLUID" 89060 CPT 5000140 CDM 301 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 CRYSTALS SNO FL+ INT 89060 CPT 5400054 CDM 300 RC Facility Outpatient 7 3.5 5.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 6 SPERM CT - POST VAS 89310 CPT 5000057 CDM 305 RC Facility Outpatient 84 42 61.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 73 SPERM CT - POAST VAS 89310 CPT 5400058 CDM 300 RC Facility Outpatient 15 7.5 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 SEMEN ANALYSIS 89320 CPT 5000563 CDM 305 RC Facility Outpatient 166 83 121.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 146 RABIES IMMUNE GLOBULIN 150U/ML 10ML 90376 CPT 7001090 CDM 636 RC Facility Outpatient 1500 UN 11312 5656 8257.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5203.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4456.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5995.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5203.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4679.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9954.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9049.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5203.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4546.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9049.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8597.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 5995.36 5995.36 5995.36 1 through 10 Percent of Total Billed Charges 5203.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4456 9954 ADMINISTRATION OF FLU VACCINE 90471 CPT 7003752 CDM 771 RC Facility Outpatient 67 33.5 73 65.74 65.74 65.74 1 through 10 Percent of Total Billed Charges 53 47.73 47.73 47.73 1 through 10 Percent of Total Billed Charges 35.8 35.8 35.8 1 through 10 Percent of Total Billed Charges 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.59 37.59 37.59 1 through 10 Percent of Total Billed Charges 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 47.73 47.73 47.73 1 through 10 Percent of Total Billed Charges 53 47.73 39.62 90.05 14 Percent of Total Billed Charges 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 ADMINISTRATION OF PNEUMONIA VACCINE 90471 CPT 7003753 CDM 771 RC Facility Outpatient 67 33.5 73 65.74 65.74 65.74 1 through 10 Percent of Total Billed Charges 53 47.73 47.73 47.73 1 through 10 Percent of Total Billed Charges 35.8 35.8 35.8 1 through 10 Percent of Total Billed Charges 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.59 37.59 37.59 1 through 10 Percent of Total Billed Charges 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 47.73 47.73 47.73 1 through 10 Percent of Total Billed Charges 53 47.73 39.62 90.05 14 Percent of Total Billed Charges 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 FLU VACCINE 0.5 ML 90661 CPT 7001072 CDM 636 RC Facility Outpatient 0.5 ML 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 PNEUMOCOCCAL (PREVNAR) VACCINE 0.5ML 90670 CPT 7005306 CDM 636 RC Facility Outpatient 0.5 ML 965 482.5 704.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 849.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 772 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 772 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 733.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380 849 RABIES VACCINE 2.5IU 90675 CPT 7001089 CDM 636 RC Facility Outpatient 2.5 UN 1290 645 941.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 683.7 683.7 683.7 1 through 10 Percent of Total Billed Charges 508.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 683.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 593.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 533.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1135.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1032 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 593.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 518.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1032 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 980.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 683.7 683.7 1290 1 through 10 Percent of Total Billed Charges 593.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508 1135 RABIES IMMUNE GLOBULIN IM 300U/ML 1ML 90675 CPT 7004889 CDM 636 RC Facility Outpatient 300 UN 2946 1473 2150.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 683.7 683.7 683.7 1 through 10 Percent of Total Billed Charges 1160.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1561.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1355.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1218.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2592.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1355.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1183.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2238.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 683.7 683.7 1290 1 through 10 Percent of Total Billed Charges 1355.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1160 2592 TETANUS TOXOID ABSORBED INJ 0.5ML 90703 CPT 13533013101 NDC 636 RC Facility Outpatient 0.5 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 TETANUS TOXOID ABSORBED INJ 0.5ML 90703 CPT 7000803 CDM 636 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 TETANUS DIPTH TOXOID ADULT INJ 0.5ML 90714 CPT 49281021515 NDC 636 RC Facility Outpatient 0.5 ML 117 117 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 62.01 62.01 62.01 1 through 10 Percent of Total Billed Charges 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 62.01 51.48 117 1 through 10 Percent of Total Billed Charges 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 TETANUS DIPTH TOXOID ADULT INJ 0.5ML 90714 CPT 7000804 CDM 636 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 62.01 62.01 62.01 1 through 10 Percent of Total Billed Charges 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 62.01 51.48 117 1 through 10 Percent of Total Billed Charges 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 TET/DIPTH/PERTUSS (Tdap) INJ 0.5ML UND 7 90715 CPT 7002184 CDM 636 RC Facility Outpatient 1 EA 120 60 73 175.2 87.6 175.2 1 through 10 Percent of Total Billed Charges 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.56 40.56 40.56 1 through 10 Percent of Total Billed Charges 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 63.6 63.6 63.6 1 through 10 Percent of Total Billed Charges 53 63.6 52.8 63.6 1 through 10 Percent of Total Billed Charges 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 TET/DIPTH/PERTUSS (Tdap) INJ 0.5ML 7&UP 90715 CPT 7002184 CDM 636 RC Facility Outpatient 120 60 73 175.2 87.6 175.2 1 through 10 Percent of Total Billed Charges 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.56 40.56 40.56 1 through 10 Percent of Total Billed Charges 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 63.6 63.6 63.6 1 through 10 Percent of Total Billed Charges 53 63.6 52.8 63.6 1 through 10 Percent of Total Billed Charges 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 PNEUMOCOCCAL (PNEUMOVAX) VACCINE 0.5ML 90732 CPT 6494300 NDC 636 RC Facility Outpatient 25 EA 341 341 248.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134 300 ZOSTAVAX SUBQ PWD FOR SOLN 19400PFU 90736 CPT 7002277 CDM 636 RC Facility Outpatient 1 UN 388 194 283.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 341.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 310.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 310.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 341 HEPATITIS B VACCINE (ENGERIX-B) ADULT 90746 CPT 58160082111 NDC 636 RC Facility Outpatient 20 EA 330 330 240.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130 290 PT SPEECH/HEARING EVAL COMP 92506 CPT 9000042 CDM 444 RC Facility Outpatient 233 116.5 170.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 205 PT SPEECH/HEARING EVAL COMP 92506 CPT 9000043 CDM 444 RC Facility Outpatient 233 116.5 170.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 205 PT SPEECH/HEARING EVAL COMP 92506 CPT 9000044 CDM 444 RC Facility Outpatient 233 116.5 170.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 205 OT SPEECH/HEARING EVAL COMP 92506 CPT 9200043 CDM 444 RC Facility Outpatient 233 116.5 170.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 205 OT SPEECH/HEARING EVAL COMP 92506 CPT 9200045 CDM 444 RC Facility Outpatient 233 116.5 170.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 205 ST SPEECH/HEARING EVAL LTD 92506 CPT 9400004 CDM 444 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 ST SPEECH/HEARING EVAL COMP 92506 CPT 9400005 CDM 444 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 117 ST TREATMENT 1 LIMITED 92507 CPT 9400009 CDM 440 RC Facility Outpatient 106 53 77.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 93 ST SPEECH/HEARING THERAPY 92507 CPT 9400010 CDM 440 RC Facility Outpatient 64 32 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 EVAL OF SPEECH SOUND PRODUCTION 92523 CPT 9400041 CDM 440 RC Facility Outpatient 234 117 170.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 177.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 205 ST BEHAVIORAL QUAL ANALY OF VOICE & RESO 92524 CPT 9400043 CDM 444 RC Facility Outpatient 337 168.5 246.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 269.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 296 PT ORAL FUNCTION THERAPY 92526 CPT 9000040 CDM 440 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 PT ORAL FUNCTION THERAPY 92526 CPT 9000041 CDM 440 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 OT DYSPHAGIA TX 92526 CPT 9200001 CDM 440 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 OT ORAL FUNCTION THERAPY 92526 CPT 9200042 CDM 440 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 OT ORAL FUNCTION THERAPY 92526 CPT 9200044 CDM 440 RC Facility Outpatient 109 54.5 79.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 ST ORAL FUNCTION THERAPY 92526 CPT 9400012 CDM 440 RC Facility Outpatient 85 42.5 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 74 PT EVALUATE SWALLOW FUNCTION 92610 CPT 9000038 CDM 444 RC Facility Outpatient 141 70.5 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 OT EVALUATE SWALLOW FUNCTION 92610 CPT 9200039 CDM 444 RC Facility Outpatient 141 70.5 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 ST DYSPHAGIA EVALUATION LTD 92610 CPT 9400006 CDM 444 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 ST DYSPHAGIA EVALUATION COMP 92610 CPT 9400007 CDM 444 RC Facility Outpatient 203 101.5 148.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 178 ST EVALUATE SWALLOW FUNCTION 92610 CPT 9400014 CDM 444 RC Facility Outpatient 130 65 94.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 114 PT MOTION FLUROSCOPY/SWALLOW 92611 CPT 9000039 CDM 444 RC Facility Outpatient 141 70.5 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 OT MOTION FLUROSCOPY/SWALLOW 92611 CPT 9200041 CDM 444 RC Facility Outpatient 141 70.5 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 ST VIDEOFLUOROSCOPY EVAL 92611 CPT 9400008 CDM 444 RC Facility Outpatient 254 127 185.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 223.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 223 ST MOTION FLUROSCOPY/SWALLOW 92611 CPT 9400015 CDM 444 RC Facility Outpatient 130 65 94.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51 114 ENDOSCOPIC EVAL SWALLOWING FEES 92612 CPT 9400042 CDM 444 RC Facility Outpatient 629 314.5 459.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 247.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 553.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 503.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 503.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 478.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 289.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 247 553 RESUSITATION 92950 CPT 9600018 CDM 480 RC Facility Outpatient 1276 638 931.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 586.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 502.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 676.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 586.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 527.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1020.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 662.64 662.64 662.64 1 through 10 Percent of Total Billed Charges 512.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1020.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 969.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 586.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 586.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 502 1122 EKG 93005 CPT 1500002 CDM 730 RC Facility Outpatient 262 131 73 138.86 138.86 191.26 1 through 10 Percent of Total Billed Charges 53 138.86 138.86 277.72 17 Percent of Total Billed Charges 103.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 209.6 108.65 211.09 1 through 10 Percent of Total Billed Charges 53 108.65 108.65 217.3 1 through 10 Percent of Total Billed Charges 109.38 109.38 109.38 1 through 10 Percent of Total Billed Charges 88 220.34 220.34 440.68 1 through 10 Percent of Total Billed Charges 209.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 136.24 115.28 136.24 1 through 10 Percent of Total Billed Charges 100 100 106.25 1 through 10 Percent of Total Billed Charges 209.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 222.7 115.28 445.4 1 through 10 Percent of Total Billed Charges 53 138.86 115.28 277.72 45 Percent of Total Billed Charges 53 108.65 108.65 224.59 1 through 10 Percent of Total Billed Charges 103 209 HOLTER MONITOR RECORDING 93225 CPT 1500003 CDM 731 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 209 HOLTER MONITOR/SCAN & ANALYSIS 93226 CPT 1500004 CDM 731 RC Facility Outpatient 476 238 347.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 418.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 361.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187 418 US ECHO 2D DOPPLER COLOR 93306 CPT 6800054 CDM 483 RC Facility Outpatient 1218 609 889.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 560.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 479.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 645.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 560.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 503.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1071.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 974.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 535.92 535.92 535.92 1 through 10 Percent of Total Billed Charges 489.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 974.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 925.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 560.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 560.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 479 1071 US ECHO LIMITED STUDY 93308 CPT 6800049 CDM 483 RC Facility Outpatient 446 223 325.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 184.95 184.95 184.95 1 through 10 Percent of Total Billed Charges 184.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 392.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 392 *US ECHO DOPPLER FOLLOW-UP LMTD STUDY 93321 CPT 6800050 CDM 483 RC Facility Outpatient 242 121 176.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 212 VENTILATOR INSTALL/CIRCUIT 94002 CPT 9600014 CDM 410 RC Facility Outpatient 1429 714.5 1043.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 563.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 757.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 591.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1257.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1143.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 574.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1143.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1086.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 657.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 563 1257 PFT/FLOW VOLUME LOOP 94010 CPT 9600017 CDM 460 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 190.4 190.4 190.4 1 through 10 Percent of Total Billed Charges 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 104.72 104.72 104.72 1 through 10 Percent of Total Billed Charges 53 98.7 98.7 98.7 1 through 10 Percent of Total Billed Charges 93 209 REVIEW PATIENT SPIROMETRY 94016 CPT 9600033 CDM 460 RC Facility Outpatient 238 119 173.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93 209 PRE AND POST BRONCHODILATOR 94060 CPT 9600022 CDM 460 RC Facility Outpatient 313 156.5 228.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 275.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 250.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 237.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123 275 INCENTIVE SPIRO TX 94150 CPT 9600024 CDM 460 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 **OXYGEN ANCILLARY FLAT RATE OR 94640 CPT 4000861 CDM 460 RC Facility Outpatient 318.08 159.04 73 148.92 148.92 148.92 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 108.12 1 through 10 Percent of Total Billed Charges 125.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.42 44.42 44.42 1 through 10 Percent of Total Billed Charges 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.59 42.2 42.59 1 through 10 Percent of Total Billed Charges 88 257.35 169.88 257.35 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 86.7 86.7 86.7 1 through 10 Percent of Total Billed Charges 53 54.06 44.88 108.12 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 125 254 PRESSURIZED OR NONPRESSURIZED INHALATION 94640 CPT 9600003 CDM 460 RC Facility Outpatient 102 51 73 148.92 148.92 148.92 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 108.12 1 through 10 Percent of Total Billed Charges 40.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.42 44.42 44.42 1 through 10 Percent of Total Billed Charges 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.59 42.2 42.59 1 through 10 Percent of Total Billed Charges 88 257.35 169.88 257.35 1 through 10 Percent of Total Billed Charges 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 81.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 86.7 86.7 86.7 1 through 10 Percent of Total Billed Charges 53 54.06 44.88 108.12 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 40 81 E-Z PAP/ IPPB TX 94640 CPT 9600015 CDM 410 RC Facility Outpatient 318.08 159.04 73 148.92 148.92 148.92 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 108.12 1 through 10 Percent of Total Billed Charges 125.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.42 44.42 44.42 1 through 10 Percent of Total Billed Charges 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.59 42.2 42.59 1 through 10 Percent of Total Billed Charges 88 257.35 169.88 257.35 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 86.7 86.7 86.7 1 through 10 Percent of Total Billed Charges 53 54.06 44.88 108.12 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 125 254 MDI TX 94640 CPT 9600026 CDM 410 RC Facility Outpatient 318.08 159.04 73 148.92 148.92 148.92 1 through 10 Percent of Total Billed Charges 53 54.06 54.06 108.12 1 through 10 Percent of Total Billed Charges 125.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 44.42 44.42 44.42 1 through 10 Percent of Total Billed Charges 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.59 42.2 42.59 1 through 10 Percent of Total Billed Charges 88 257.35 169.88 257.35 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 86.7 86.7 86.7 1 through 10 Percent of Total Billed Charges 53 54.06 44.88 108.12 1 through 10 Percent of Total Billed Charges 53 42.3 42.3 42.3 1 through 10 Percent of Total Billed Charges 125 254 CONTINUOUS BRONCHODILATOR/ INITIAL 94644 CPT 85000034 CDM 270 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 CONTINUOUS INHALATION TX FIRST HOUR 94644 CPT 9600100 CDM 460 RC Facility Outpatient 150 75 109.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 132 CONTINUOUS INHALATION TX EA ADDL HOUR 94645 CPT 9600101 CDM 460 RC Facility Outpatient 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 CPAP TITRATION CONT POS AIRW PRESSUR 94660 CPT 9600007 CDM 410 RC Facility Outpatient 417 208.5 304.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 366.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 191.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 366 CONTINOUS CPAP/BIPAP THERAPY 94660 CPT 9600013 CDM 410 RC Facility Outpatient 536 268 391.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 471.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 428.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 428.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 407.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211 471 INCENTIVE SPIROMETERY INS 94664 CPT 9600020 CDM 410 RC Facility Outpatient 318.08 159.04 232.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.91 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.74 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125 279 AEROSOL MIST NEBULIZER/INITIAL 94664 CPT 9600028 CDM 410 RC Facility Outpatient 318.08 159.04 232.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.91 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.46 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.74 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125 279 CPT/PERCUSSION TX INITIAL 94667 CPT 9600009 CDM 410 RC Facility Outpatient 84 42 61.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 73 CPT/PERCUSSION TX SUBS 94668 CPT 9600023 CDM 410 RC Facility Outpatient 66 33 48.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 PULSE OX SPOT CHECK 94760 CPT 9600021 CDM 460 RC Facility Outpatient 101 50.5 73.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 80.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 46.46 46.46 46.46 1 through 10 Percent of Total Billed Charges 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 88 PEAK FLOW TEST/EVALUATION 94799 CPT 9600027 CDM 410 RC Facility Outpatient 276.13 138.06 201.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 242.99 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.9 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.9 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.86 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 242 SLEEP STUDY - UNATTENDED 95806 CPT 9600011 CDM 740 RC Facility Outpatient 646 323 471.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 342.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 568.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 516.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 516.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 490.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 297.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254 568 SLEEP STUDY - INITIAL 95810 CPT 9600006 CDM 740 RC Facility Outpatient 2441 1220.5 1781.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 961.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1293.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1009.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2148.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1952.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 980.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1952.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1855.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1122.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 961 2148 CPAP TITRATION SLEEP STUDY 95811 CPT 9600008 CDM 740 RC Facility Outpatient 2857 1428.5 2085.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1314.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1125.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1514.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1314.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1181.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2514.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2285.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1314.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1148.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2285.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2171.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1314.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1314.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1125 2514 PT ASSESSMENT OF APHASIA 96105 CPT 9000031 CDM 440 RC Facility Outpatient 222.63 111.31 162.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.91 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 195 OT ASSESSMENT OF APHASIA 96105 CPT 9200035 CDM 440 RC Facility Outpatient 222.63 111.31 162.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.91 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 195 ST ASSESSMENT OF APHASIA 96105 CPT 9400011 CDM 440 RC Facility Outpatient 222.63 111.31 162.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 195.91 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.1 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 169.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.41 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 195 STANDARDIZED COGNITIVE PERFORMANCE TESTI 96125 CPT 9400049 CDM 440 RC Facility Outpatient 150 75 109.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 132 IV THERAPY INITIAL HR 96365 CPT 3000128 CDM 260 RC Facility Outpatient 209 104.5 73 110.77 110.77 110.77 1 through 10 Percent of Total Billed Charges 53 110.77 110.77 110.77 1 through 10 Percent of Total Billed Charges 82.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 86.67 86.67 86.67 1 through 10 Percent of Total Billed Charges 53 86.67 86.67 86.67 1 through 10 Percent of Total Billed Charges 86.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 209 209 209 1 through 10 Percent of Total Billed Charges 83.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 176.8 96.14 176.8 1 through 10 Percent of Total Billed Charges 53 91.96 91.52 91.96 1 through 10 Percent of Total Billed Charges 96.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82 183 IV THERAPY EA SUBSEQUENT HOUR 96366 CPT 3000129 CDM 260 RC Facility Outpatient 65 32.5 47.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 26.95 26.95 26.95 1 through 10 Percent of Total Billed Charges 26.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 65 65 65 1 through 10 Percent of Total Billed Charges 26.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 IV THERAPY EA ADDTL SUBSEQUENT HOUR 96367 CPT 3000637 CDM 260 RC Facility Outpatient 65 32.5 47.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 65 65 65 1 through 10 Percent of Total Billed Charges 26.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 "THERAPEUTIC,PROPHYLACTIC INJECTION SUBQ/" 96372 CPT 9600095 CDM 520 RC Facility Outpatient 90.05 45.02 73 65.74 47.73 65.74 1 through 10 Percent of Total Billed Charges 53 47.73 47.73 47.73 13 Percent of Total Billed Charges 35.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72.55 18.88 450.25 1 through 10 Percent of Total Billed Charges 53 37.34 37.34 37.34 1 through 10 Percent of Total Billed Charges 37.59 37.59 37.59 1 through 10 Percent of Total Billed Charges 79.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.04 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 18.24 100 18 Percent of Total Billed Charges 72.04 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76.54 39.62 79.24 1 through 10 Percent of Total Billed Charges 53 47.73 39.62 47.73 68 Percent of Total Billed Charges 53 37.34 37.34 38.6 1 through 10 Percent of Total Billed Charges 35 79 "THERAPEUTIC,PROPHYLACTIC INJECTION SUBQ/" 96372 CPT 96000953 CDM 963 RC Facility Outpatient 90.05 45.02 73 65.74 47.73 65.74 1 through 10 Percent of Total Billed Charges 53 47.73 47.73 47.73 13 Percent of Total Billed Charges 35.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72.55 18.88 450.25 1 through 10 Percent of Total Billed Charges 53 37.34 37.34 37.34 1 through 10 Percent of Total Billed Charges 37.59 37.59 37.59 1 through 10 Percent of Total Billed Charges 79.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.04 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 18.24 100 18 Percent of Total Billed Charges 72.04 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76.54 39.62 79.24 1 through 10 Percent of Total Billed Charges 53 47.73 39.62 47.73 68 Percent of Total Billed Charges 53 37.34 37.34 38.6 1 through 10 Percent of Total Billed Charges 35 79 "THERAPEUTIC,PROPHYLACTIC INJECTION SUBQ/" 96372 CPT 97963723 CDM 963 RC Facility Outpatient 70 35 73 65.74 47.73 65.74 1 through 10 Percent of Total Billed Charges 53 47.73 47.73 47.73 13 Percent of Total Billed Charges 27.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 72.55 18.88 450.25 1 through 10 Percent of Total Billed Charges 53 37.34 37.34 37.34 1 through 10 Percent of Total Billed Charges 37.59 37.59 37.59 1 through 10 Percent of Total Billed Charges 61.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 18.24 100 18 Percent of Total Billed Charges 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 76.54 39.62 79.24 1 through 10 Percent of Total Billed Charges 53 47.73 39.62 47.73 68 Percent of Total Billed Charges 53 37.34 37.34 38.6 1 through 10 Percent of Total Billed Charges 27 61 ST EVALUATION 15 MIN 97001 CPT 9400031 CDM 424 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 PT RE EVALUATION 97002 CPT 9000025 CDM 434 RC Facility Outpatient 43 21.5 31.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 37 OT EVALUATION 15 MIN 97003 CPT 9200003 CDM 434 RC Facility Outpatient 182.93 91.46 133.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.15 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.15 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.98 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.34 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.15 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.34 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.03 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.15 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.15 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 160 ST EVALUATION 15 MIN 97003 CPT 9400018 CDM 434 RC Facility Outpatient 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 OT RE EVALUATION 97004 CPT 9200015 CDM 434 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 ST RE EVALUATION 97004 CPT 9400022 CDM 434 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 PT PARAFFIN BATH 97018 CPT 9000024 CDM 434 RC Facility Outpatient 22.03 11.01 16.08 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.39 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.74 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 OT PARAFFIN BATH 97018 CPT 9200016 CDM 434 RC Facility Outpatient 22.03 11.01 16.08 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.39 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.74 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 ST PARAFFIN BATH 97018 CPT 9400021 CDM 434 RC Facility Outpatient 22.03 11.01 16.08 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.39 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.62 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.74 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.13 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 PT WHIRLPOOL 97022 CPT 9000018 CDM 424 RC Facility Outpatient 47.28 23.64 34.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.61 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.93 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 OT WHIRLPOOL 97022 CPT 9200034 CDM 424 RC Facility Outpatient 47.28 23.64 34.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.61 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.93 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 ST WHIRLPOOL 97022 CPT 9400040 CDM 424 RC Facility Outpatient 47.28 23.64 34.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.61 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.82 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.93 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.75 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 PT ELECTRIC STIMULATION 15 MIN ATTEND 97032 CPT 9000004 CDM 420 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 OT ELECTRIC STIMULATION 15 MIN ATTEND 97032 CPT 9200023 CDM 420 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 ST ELECTRIC STIMULATION 15 MIN ATTEND 97032 CPT 9400030 CDM 420 RC Facility Outpatient 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 PT ELECTRIC CURRENT THERAPY 97033 CPT 9000009 CDM 420 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 OT IONTOPHORESIS 97033 CPT 9000047 CDM 434 RC Facility Outpatient 84 42 61.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 73 OT ELECTRIC CURRENT THERAPY 97033 CPT 9200022 CDM 420 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 ST ELECTRIC CURRENT THERAPY 97033 CPT 9400029 CDM 420 RC Facility Outpatient 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 PT ULTRASOUND 15 MIN 97035 CPT 9000006 CDM 420 RC Facility Outpatient 14 7 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 PT ULTRASOUND 15 MIN 97035 CPT 9000029 CDM 430 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 OT ULTRASOUND 15 MIN 97035 CPT 9200006 CDM 430 RC Facility Outpatient 14 7 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 OT ULTRASOUND 15 MIN 97035 CPT 9200032 CDM 420 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 ST ULTRASOUND 15 MIN 97035 CPT 9400026 CDM 430 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 ST ULTRASOUND 15 MIN 97035 CPT 9400038 CDM 420 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 PT THER EXER/POSIT 15 MIN 97110 CPT 9000027 CDM 430 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 PT THERAPEUTIC EXERCISE 97110 CPT 9000045 CDM 440 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 OT THER EXER/POSIT 15 MIN 97110 CPT 9200007 CDM 430 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 OT THER/EXERCISE 15 MIN 97110 CPT 9200030 CDM 430 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 OT THERAPEUTIC EXERCISE 97110 CPT 9200046 CDM 430 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 ST THERAPEUTIC EXERCISE 97110 CPT 9400003 CDM 440 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 ST THER EXER/POSIT 15 MIN 97110 CPT 9400024 CDM 430 RC Facility Outpatient 61 30.5 44.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 53 ST THER/EXERCISE 15 MIN 97110 CPT 9400036 CDM 420 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 PT BALANCE REEDUCATION 15 MIN 97112 CPT 9000013 CDM 420 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 PT NEURO RE-EDUCATION 97112 CPT 9000023 CDM 420 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 OT NEURO RE-EDUCATION 97112 CPT 9200002 CDM 430 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 OT NEURO MUSCULAR REEDUCATION 15 MIN 97112 CPT 9200004 CDM 430 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 OT BALANCE REEDUCATION 15 MIN 97112 CPT 9200021 CDM 430 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 ST NEUROMUSCULAR REEDUCATION 97112 CPT 9400013 CDM 440 RC Facility Outpatient 41 20.5 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 ST NEURO RE-EDUCATION 97112 CPT 9400020 CDM 440 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 ST BALANCE REEDUCATION 15 MIN 97112 CPT 9400028 CDM 440 RC Facility Outpatient 31 15.5 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 OT GAIT TRAIN 15 MIN 97116 CPT 9200025 CDM 420 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 ST GAIT TRAIN 15 MIN 97116 CPT 9400032 CDM 420 RC Facility Outpatient 57 28.5 41.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 PT MASSAGE THERAPY 97124 CPT 9000011 CDM 420 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 PT SOFT TISSUE MASSAGE 15 MIN 97124 CPT 9000026 CDM 430 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 OT SOFT TISSUE MASSAGE 15 MIN 97124 CPT 9200005 CDM 430 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 OT MASSAGE THERAPY 97124 CPT 9200026 CDM 420 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 ST SOFT TISSUE MASSAGE 15 MIN 97124 CPT 9400023 CDM 430 RC Facility Outpatient 60 30 43.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 52 ST MASSAGE THERAPY 97124 CPT 9400033 CDM 420 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 ST THERAPEUTIC INTERVENTION COGNI INITIA 97129 CPT 9400050 CDM 430 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 ST THERAPEUTIC INTERVENTION COGNI ADD'L 97130 CPT 9400051 CDM 430 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 PT MANUAL THERAPY 97140 CPT 9000015 CDM 420 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 PT JOINT MOBILIZATION 97140 CPT 9000022 CDM 430 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 OT JOINT MOBILIZATION 97140 CPT 9200010 CDM 430 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 OT MYOFASCIAL RELEASE 97140 CPT 9200047 CDM 430 RC Facility Outpatient 117 58.5 85.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 102 ST JOINT MOBILIZATION 97140 CPT 9400019 CDM 430 RC Facility Outpatient 82 41 59.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.46 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 72 PT GROUP THERAPY 97150 CPT 9000046 CDM 434 RC Facility Outpatient 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 OT GROUP THERAPY 97150 CPT 9200017 CDM 434 RC Facility Outpatient 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 ST GROUP THERAPY 97150 CPT 9400047 CDM 434 RC Facility Outpatient 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 OT COGNIT/PERCEPT TRAIN 15 MIN 97532 CPT 9000020 CDM 430 RC Facility Outpatient 71 35.5 51.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 62 PT COGNITIVE SKILLS DEVELOPMENT 97532 CPT 9000036 CDM 440 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 OT COGNITIVE SKILLS DEVELOPMENT 97532 CPT 9200038 CDM 440 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 ST COGNITIVE SKILLS DEVELOPMENT 97532 CPT 9400001 CDM 440 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 ST COGNIT/PERCEPT TRAIN 15 MIN 97532 CPT 9400017 CDM 430 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 SENSORY INTEGRATION 97533 CPT 9099003 CDM 420 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 ST SENSORY INTEGRATION 97533 CPT 9400046 CDM 440 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 PT A-D-L 15 MIN 97535 CPT 9000019 CDM 430 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 OT A-D-L 15 MIN 97535 CPT 9200008 CDM 430 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 ST A-D-L 15 MIN 97535 CPT 9400016 CDM 430 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 COMMUNITY/WORK REINTEGRATION 97537 CPT 9000053 CDM 420 RC Facility Outpatient 34 17 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 COMM/WORK REINTEGRAT 97537 CPT 9200020 CDM 434 RC Facility Outpatient 34 17 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 PT WHEELCHAIR TRAINING 15 MIN 97542 CPT 9000017 CDM 420 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 PT WHEELCHAIR MANAGEMENT & TRAINING 97542 CPT 9000030 CDM 430 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 OT WHEELCHAIR MANAGEMENT & TRAINING 97542 CPT 9200014 CDM 430 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 OT WHEELCHAIR TRAINING 15 MIN 97542 CPT 9200033 CDM 420 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 ST WHEELCHAIR MANAGEMENT & TRAINING 97542 CPT 9400027 CDM 430 RC Facility Outpatient 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 ST WHEELCHAIR TRAINING 15 MIN 97542 CPT 9400039 CDM 420 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 DEBRIDEMENT OPEN WND WHIRLPOOL 20 SQ 97597 CPT 97975971 CDM 960 RC Facility Outpatient 73 36.5 53.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 64 DEBRIDEMENT OPEN WND WHIRLPOOL 20 SQ 97597 CPT 97975972 CDM 520 RC Facility Outpatient 73 36.5 53.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 64 DEBRIDEMENT OPEN WND WHIRLPOOL 20 SQ 97597 CPT 97975973 CDM 963 RC Facility Outpatient 73 36.5 53.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 64 PT DEBRIDEMENT 97602 CPT 9000002 CDM 420 RC Facility Outpatient 250.75 125.37 183.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 REM DEVITALIZED TISSUE FROM WOUND 97602 CPT 97976021 CDM 960 RC Facility Outpatient 250.75 125.37 183.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 REM DEVITALIZED TISSUE FROM WOUND 97602 CPT 97976022 CDM 520 RC Facility Outpatient 250.75 125.37 183.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 REM DEVITALIZED TISSUE FROM WOUND 97602 CPT 97976023 CDM 963 RC Facility Outpatient 250.75 125.37 183.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.35 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 NEGATIVE PRESSURE WOUND THERAPY 97605 CPT 97976051 CDM 960 RC Facility Outpatient 82 41 59.86 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.46 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 72 PT ORTHOTIC FITTING 15 MIN 97760 CPT 9000014 CDM 420 RC Facility Outpatient 61 30.5 44.53 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 53 PT ORTHOTIC MGMT AND TRAINING 97760 CPT 9099004 CDM 424 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 ORTHO MGMT AND TRAINING 97760 CPT 9200018 CDM 434 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 OT ORTHOTIC MGMT AND TRAINING 97760 CPT 9200027 CDM 424 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 ST ORTHOTIC MGMT AND TRAINING 97760 CPT 9400034 CDM 424 RC Facility Outpatient 33 16.5 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 PT PROSTHETIC TRAINING 97761 CPT 9200019 CDM 434 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 ST PROSTHETIC TRAINING 97761 CPT 9400035 CDM 434 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 PT PROSTHETIC TRAINING 97763 CPT 9000054 CDM 434 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 COMPUTER DATA ANALYSIS 99090 CPT 5600050 CDM 391 RC Facility Outpatient 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 CONSCIOUS SEDATION INIT 15MINS 5 YRS > 99152 CPT 2000094 CDM 360 RC Facility Outpatient 298 149 217.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 262.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 238.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 226.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117 262 PHLEBOTOMY-THERAPEUT 99195 CPT 5400029 CDM 300 RC Facility Outpatient 170 85 124.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 149 BB SPECIAL SERVICE / PROCEDURE / REPORT 99199 CPT 5600051 CDM 305 RC Facility Outpatient 52 26 37.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 45 BB RARE UNIT FEE 99199 CPT 5600052 CDM 305 RC Facility Outpatient 124 62 90.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 109 OBSERVATION DISCHARGE 99217 CPT 8700418 CDM 762 RC Facility Outpatient 207 103.5 151.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 182.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81 182 OBS 1ST DAY LEVEL 1 99218 CPT 8700402 CDM 762 RC Facility Outpatient 259 129.5 189.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102 227 OBS 1ST DAY LEVEL 2 99219 CPT 8700403 CDM 762 RC Facility Outpatient 342 171 249.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 273.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 273.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134 300 OBS 1ST DAY LEVEL 3 99220 CPT 8700404 CDM 762 RC Facility Outpatient 501 250.5 365.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 440.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 380.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197 440 HOSPITAL ADMIT LEVEL 1 99221 CPT 8700170 CDM 987 RC Facility Outpatient 269 134.5 196.37 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.57 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105 236 HOSPITAL ADMIT LEVEL 2 99222 CPT 8700171 CDM 987 RC Facility Outpatient 342 171 249.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 273.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 273.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134 300 HOSPITAL ADMIT LEVEL 2 99222 CPT 97992221 CDM 960 RC Facility Outpatient 435 217.5 317.55 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.55 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 382.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 348 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 348 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 330.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171 382 HOSPITAL ADMIT LEVEL 3 99223 CPT 8700172 CDM 987 RC Facility Outpatient 502 251 366.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 266.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 441.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 401.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 201.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 401.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 381.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197 441 HOSPITAL ADMIT LEVEL 3 99223 CPT 97001720 CDM 520 RC Facility Outpatient 640 320 467.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 339.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 563.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 257.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 486.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252 563 HOSPITAL SUB VISIT LEVEL 1 99231 CPT 8700163 CDM 987 RC Facility Outpatient 110 55 80.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 96 HOSPITAL SUB VISIT LEVEL 2 99232 CPT 8700164 CDM 987 RC Facility Outpatient 184 92 134.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72 161 HOSPITAL SUB VISIT LEVEL 3 99233 CPT 8700165 CDM 987 RC Facility Outpatient 272 136 198.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 217.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107 239 HOSPITAL ADMIT/DISCH SAME DAY LEVEL 1 99234 CPT 8700166 CDM 987 RC Facility Outpatient 352 176 256.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 309 OBS ADMIT/DISCH SAME DAY LEVEL 1 99234 CPT 8700406 CDM 762 RC Facility Outpatient 352 176 256.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 145.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 267.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138 309 HOSPITAL ADMIT/DISCH SAME DAY LEVEL 2 99235 CPT 8700167 CDM 987 RC Facility Outpatient 468 234 341.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 248.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 355.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 411 OBS ADMIT/DISCH SAME DAY LEVEL 2 99235 CPT 8700407 CDM 762 RC Facility Outpatient 468 234 341.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 248.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 374.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 355.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 411 HOSPITAL ADMIT/DISCH SAME DAY LEVEL 3 99236 CPT 8700168 CDM 987 RC Facility Outpatient 727 363.5 530.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 639.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 581.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 292.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 581.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286 639 OBS ADMIT/DISCH SAME DAY LEVEL 3 99236 CPT 8700408 CDM 762 RC Facility Outpatient 727 363.5 530.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 639.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 581.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 292.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 581.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 286 639 HOSPITAL IP DISCH DAY 30 MIN OR < 99238 CPT 8700169 CDM 987 RC Facility Outpatient 195 97.5 142.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 HOSPITAL IP DISCH DAY > 30 MIN 99239 CPT 8700162 CDM 987 RC Facility Outpatient 292 146 213.16 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 233.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115 256 CRITICAL CARE 30-74 MINUTES 99291 CPT 8700420 CDM 960 RC Facility Outpatient 1153 576.5 841.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 530.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 454.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 611.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 530.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 477 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1014.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 922.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 1489 1489 1489 1 through 10 Percent of Total Billed Charges 463.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 922.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 876.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 530.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 530.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 454 1014 CRITICAL CARE ADDL 30 MINUTES 99292 CPT 8700421 CDM 960 RC Facility Outpatient 641 320.5 467.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 339.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 564.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 352 352 352 1 through 10 Percent of Total Billed Charges 257.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 512.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 294.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 252 564 TRAY CATH 16FR FOLEY A4314 HCPCS 4001053 CDM 272 RC Facility Outpatient 18 9 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 RAPID RHINO A4314 HCPCS 40041055 CDM 272 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 ADHESIVE PAD REMOVER A4456 HCPCS 4000961 CDM 272 RC Facility Outpatient 1 0.5 0.73 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.53 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 FINGER/THUMB SPLINT BEIGE/LG. A4570 HCPCS 4000561 CDM 274 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 FINGER/THUMB SPLINT BEIGE/SM A4570 HCPCS 4000649 CDM 274 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 FINGER/THUMB SPLINT BEIGE/MED. A4570 HCPCS 4000650 CDM 274 RC Facility Outpatient 23 11.5 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 COMFORT/WRIST / THUMB LEFT LARGE A4570 HCPCS 40010034 CDM 274 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 COMFORT WRIST / THUMB RIGHT LARGE A4570 HCPCS 40010035 CDM 274 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 COMFORT WRIST / THUMB MED LT A4570 HCPCS 40010036 CDM 274 RC Facility Outpatient 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 9.6 9.6 1 through 10 Percent of Total Billed Charges 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 EXUDERN DRESSING ODORSHIELD 6.4'' X 6.5' A6235 HCPCS 4000939 CDM 272 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 DRESSING EXUDERM ODORSHIELD 4'' X 3.6'' A6237 HCPCS 4000960 CDM 272 RC Facility Outpatient 14 7 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 SHOE MD WOMEN POST-OP A9270 HCPCS 4001056 CDM 274 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 SHOE LG WOMEN POST-OP A9270 HCPCS 4001057 CDM 274 RC Facility Outpatient 59 29.5 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 PROHANCE INJECTION 279.3MG/ML A9579 HCPCS 7002285 CDM 636 RC Facility Outpatient 279.3 ME 672 336 490.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 278.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 591.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 537.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 270.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 537.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 510.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 309.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264 591 OXYGEN NASAL CANNULA & HUMIDIFIER KIT E0580 HCPCS 4000105 CDM 272 RC Facility Outpatient 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 MASK OXY MED CONCEN ELONG ADULT E0580 HCPCS 4000106 CDM 272 RC Facility Outpatient 2 1 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 WATER STERILE AQUAPACK W/ADAPTOR E0580 HCPCS 4001059 CDM 272 RC Facility Outpatient 3.33 1.66 2.43 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.53 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.53 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.93 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.53 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.53 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.53 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.53 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 2 THIN PREP CYTOLOGY G0123 HCPCS 5200022 CDM 311 RC Facility Outpatient 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 OT COGNIT/PERCEPT TRAIN 15 MIN G0515 HCPCS 9200009 CDM 430 RC Facility Outpatient 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 ST COGNITIVE SKILLS DEVELOPMENT G0515 HCPCS 9400048 CDM 440 RC Facility Outpatient 45 22.5 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 ACYCLOVIR (ZOVIRAX) VIAL 500 MG / 10 ML J0133 HCPCS 63323032510 NDC 636 RC Facility Outpatient 50 ME 83 83 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 ACYCLOVIR (ZOVIRAX) VIAL 500 MG / 10 ML J0133 HCPCS 7003512 CDM 636 RC Facility Outpatient 500 ME 70 35 51.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 61 ADENOSINE (ADENOCARD) IV 6MG/2ML J0153 HCPCS 17478054202 NDC 636 RC Facility Outpatient 3 ME 65.7 65.7 47.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.82 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.93 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 ADENOSINE (ADENOCARD) IV 12MG/4ML J0153 HCPCS 7002256 CDM 636 RC Facility Outpatient 12 ME 195 97.5 142.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 EPinephRINE 1 to 1000 1ML AMP 1MG J0171 HCPCS 54288010310 NDC 636 RC Facility Outpatient 1 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.77 4.77 4.77 1 through 10 Percent of Total Billed Charges 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 "EPinephRINE 1 to 10,000-10ML SYRINGE 1MG" J0171 HCPCS 76329331601 NDC 636 RC Facility Outpatient 1 ME 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.77 4.77 4.77 1 through 10 Percent of Total Billed Charges 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 EPinephRINE 1 to 1000 (1MG/ML) MDV 30ML J0171 HCPCS 76329906000 NDC 636 RC Facility Outpatient 30 ME 48 48 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.77 4.77 4.77 1 through 10 Percent of Total Billed Charges 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 42 AMINOPHYLLINE INJECTION 500MG/20ML J0280 HCPCS 7001085 CDM 636 RC Facility Outpatient 500 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 AMIODARONE HCL VIAL 150 MG / 3 ML J0282 HCPCS 7001065 CDM 636 RC Facility Outpatient 150 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 AMIODARONE VIAL 900 MG / 18 ML J0282 HCPCS 7001066 CDM 636 RC Facility Outpatient 900 ME 51 25.5 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 AMPICILLIN VIAL 1 GRAM J0290 HCPCS 55150011310 NDC 636 RC Facility Outpatient 1 GM 39 39 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 AMPICILLIN VIAL 2 GRAM J0290 HCPCS 7002309 CDM 636 RC Facility Outpatient 2 GM 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 AMPICILLIN/SULBACT (UNASYN) VIAL 1.5 GM J0295 HCPCS 63323036820 NDC 636 RC Facility Outpatient 1.5 GM 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 AMPICILLIN/SULBACTAM (UNASYN) VIAL 3 GM J0295 HCPCS 63323036920 NDC 636 RC Facility Outpatient 3 GM 49 49 35.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 43 AMPICILLIN/SULBACT (UNASYN) VIAL 1.5 GM J0295 HCPCS 7000843 CDM 636 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 SUCCINYLCHOLINE (ANECTINE) 20MG/ML 10ML J0330 HCPCS 409662902 NDC 636 RC Facility Outpatient 20 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 SUCCINYLCHOLINE (ANECTINE) 20MG/ML 10ML J0330 HCPCS 7000809 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 hydrALAZINE (APRESOLINE) VIAL 1ML 20MG J0360 HCPCS 63323061401 NDC 636 RC Facility Outpatient 20 ME 97 97 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 AZITHROMYCIN (ZITHROMAX) INJ 500 MG J0456 HCPCS 25021011210 NDC 636 RC Facility Outpatient 500 ME 50 50 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.62 21.62 21.62 1 through 10 Percent of Total Billed Charges 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 AZITHROMYCIN (ZITHROMAX) 500MG INJ J0456 HCPCS 70436001982 NDC 636 RC Facility Outpatient 500 ME 47 47 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.62 21.62 21.62 1 through 10 Percent of Total Billed Charges 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 AZITHROMYCIN (ZITHROMAX) INJ 500 MG J0456 HCPCS 7000818 CDM 636 RC Facility Outpatient 50 25 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 21.62 21.62 21.62 1 through 10 Percent of Total Billed Charges 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 ATROPINE SULFATE INJ 1 ML 0.4 MG J0461 HCPCS 517040125 NDC 636 RC Facility Outpatient 0.4 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 ATROPINE SULFATE INJ 0.4MG/1ML 20 ML J0461 HCPCS 7002268 CDM 636 RC Facility Outpatient 0.4 ME 93 46.5 67.89 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.29 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 81 DICYCLOMINE (BENTYL) IM SOLN 2ML 20MG J0500 HCPCS 7004711 CDM 636 RC Facility Outpatient 20 ME 129 64.5 94.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 113 PEN G BENZ/PEN G PROCAINE VIAL 600 MU/ML J0558 HCPCS 60793013010 NDC 636 RC Facility Outpatient 1 ML 76 76 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 PEN G BENZ/PENG PROCAINE 2ML SYR 1.2MMU J0558 HCPCS 60793060010 NDC 636 RC Facility Outpatient 2 ML 258 258 188.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101 227 PEN G BENZ/PEN G PROCAINE 1.2MMU/2ML VL J0558 HCPCS 60793060110 NDC 636 RC Facility Outpatient 2 ML 162 162 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 BICILLIN CR 2.4MMU SYR J0558 HCPCS 60793070210 NDC 636 RC Facility Outpatient 4 ML 318 318 232.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 279.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 254.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 125 279 PEN G BENZ/PEN G PROCAINE VIAL 600 MU/ML J0558 HCPCS 7000769 CDM 636 RC Facility Outpatient 76 38 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 PEN G BENZ/PEN G PROCAINE 1.2MMU/2ML VL J0558 HCPCS 7000854 CDM 636 RC Facility Outpatient 162 81 118.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63 142 BICILLIN LA 600MU SYR J0561 HCPCS 60793070010 NDC 636 RC Facility Outpatient 1 ML 118 118 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 PENICILLIN G BENZ 600MU/ML VIAL 1ML J0561 HCPCS 60793070010 NDC 636 RC Facility Outpatient 1 ML 118 118 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 PEN G BENZ (BICILLIN LA) SYR 2ML 1.2MMU J0561 HCPCS 60793070110 NDC 636 RC Facility Outpatient 2 ML 323 323 235.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 284.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 258.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 245.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 148.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127 284 PEN G BENZ (BICILLIN LA) SYR 2ML 1.2MU J0561 HCPCS 61570014710 NDC 636 RC Facility Outpatient 2 ML 203 203 148.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 178 PEN G BENZ (BICILLIN LA) SYR 2ML 1.2MU J0561 HCPCS 7000771 CDM 636 RC Facility Outpatient 203 101.5 148.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 178 PENICILLIN G BENZ 600MU/ML VIAL 1ML J0561 HCPCS 7000853 CDM 636 RC Facility Outpatient 118 59 86.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 27.36 100 1 through 10 Percent of Total Billed Charges 94.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 171.19 171.19 171.19 1 through 10 Percent of Total Billed Charges 54.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46 103 BOTULINUM TOXIN (BOTOX) VIAL 100 UNITS J0585 HCPCS 23114501 NDC 636 RC Facility Outpatient 100 UN 3245 3245 2368.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1278.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1719.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1342.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2855.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2596 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1304.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2596 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2466.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1278 2855 BOTULINUM TOXIN (BOTOX) VIAL 100 UNITS J0585 HCPCS 7000669 CDM 636 RC Facility Outpatient 3245 1622.5 2368.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1278.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1719.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1342.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2855.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2596 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1304.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2596 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2466.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1492.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1278 2855 BOTULINUM TOXIN (BOTOX) VIAL 200 UNITS J0585 HCPCS 7005181 CDM 636 RC Facility Outpatient 200 UN 6489 3244.5 4736.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2984.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2556.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3439.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2984.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2684.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5710.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2984.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2607.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5191.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4931.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2984.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2984.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2556 5710 CALCITONIN (MIACALCIN) INJECT 1ML 200IU J0630 HCPCS 7004902 CDM 636 RC Facility Outpatient 200 F2 178 89 129.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70 156 ceFAZolin (ANCEF) INJ 1GM J0690 HCPCS 44567070725 NDC 636 RC Facility Outpatient 1 GM 21 21 73 30.66 30.66 30.66 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 ceFAZolin (ANCEF)PREDEFINED 1GM/NS 100ML J0690 HCPCS 7000905 CDM 636 RC Facility Outpatient 1 GM 83 41.5 73 30.66 30.66 30.66 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 ceFAZolin (ANCEF)PREDEFINED 100ML 2GM J0690 HCPCS 7000906 CDM 636 RC Facility Outpatient 2 GM 83 41.5 73 30.66 30.66 30.66 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 ceFAZolin(ANCEF)PREDEFINED 50ML 500MG J0690 HCPCS 7000907 CDM 636 RC Facility Outpatient 500 ME 83 41.5 73 30.66 30.66 30.66 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 CEFOxitin (MEFOXIN) VIAL 1GM J0692 HCPCS 60505083404 NDC 636 RC Facility Outpatient 1 GM 51 51 37.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 44 CEFEPIME (MAXIPIME) INJ 2GM J0692 HCPCS 7002318 CDM 636 RC Facility Outpatient 2 GM 203 101.5 148.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 162.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 79 178 CEFEPIME (MAXIPIME) INJ 1GM J0692 HCPCS 7005059 CDM 636 RC Facility Outpatient 1 GM 39 19.5 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 cefTRIAXone (ROCEPHIN) VIAL 250MG J0696 HCPCS 409733701 NDC 636 RC Facility Outpatient 250 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 cefTRIAXone (ROCEPHIN) VIAL 2GM J0696 HCPCS 7003712 CDM 636 RC Facility Outpatient 2 GM 194 97 141.62 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 170 cefTAZidime (FORTAZ) VIAL 1GM J0713 HCPCS 409508216 NDC 636 RC Facility Outpatient 1 GM 62 62 45.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.86 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 54 FORTAZ (cefTAZidime) VIAL 500 MG J0713 HCPCS 7002299 CDM 636 RC Facility Outpatient 500 ME 17 8.5 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 IMIPENEM/CILAS (PRIMAXIN) IVPB 500MG J0743 HCPCS 6351659 NDC 636 RC Facility Outpatient 500 ME 205 205 149.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 180 PRIMAXIN IV 250MG VIAL J0743 HCPCS 7004947 CDM 636 RC Facility Outpatient 250 ME 110 55 80.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 96 PROCHLORPERAZINE(COMPAZINE) VL 2ML 10MG J0780 HCPCS 7001198 CDM 636 RC Facility Outpatient 10 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 CORTROSYN (COSYNTROPIN) INJ 0.25MG J0834 HCPCS 7001160 CDM 636 RC Facility Outpatient 0.2 ME 731 365.5 533.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 387.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 302.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 643.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 584.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 293.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 584.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 555.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288 643 SNAKE ANTIVENOM (CROFAB) INJECTION VIAL J0840 HCPCS 7001083 CDM 636 RC Facility Outpatient 1 EA 9232 4616 6739.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4246.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3637.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4892.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4246.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3819.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8124.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7385.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4246.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3710.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7385.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7016.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4246.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4246.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3637 8124 DARBEPOETIN (ARANESP) SDV 60MCG/1ML J0881 HCPCS 7004989 CDM 636 RC Facility Outpatient 60 EA 390 195 284.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 343.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 312 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153 343 EPOETIN ALFA (PROCRIT) VIAL 10000 UNIT J0885 HCPCS 59676031001 NDC 636 RC Facility Outpatient 10000 UN 952 952 694.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 375.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 504.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 393.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 761.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 382.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 761.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 723.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 437.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 375 837 "EPOGEN (PROCRIT) VIAL 1ML 40,000 UNIT" J0885 HCPCS 7002505 CDM 636 RC Facility Outpatient 40000 UN 3004 1502 2192.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1381.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1183.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1592.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1381.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1242.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2643.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2403.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1381.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1207.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2403.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2283.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1381.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1381.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1183 2643 "EPOETIN (PROCRIT) VIAL 1ML 20,000 UNIT" J0885 HCPCS 7002516 CDM 636 RC Facility Outpatient 20000 UN 2629 1314.5 1919.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1209.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1035.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1393.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1209.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1087.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2313.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1209.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1056.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1998.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1209.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1209.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1035 2313 DEFEROXAMINE MESYLATE INJ PWD FOR SOLN 5 J0895 HCPCS 7002289 CDM 636 RC Facility Outpatient 1 UN 58 29 42.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 51 ESTRADIOL (DEPO-ESTRADIOL) INJ 5MG/1ML J1000 HCPCS 7002288 CDM 636 RC Facility Outpatient 5 ME 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 METHYLPREDNISOLONE ACETATE(DEPO-MEDROL) J1040 HCPCS 703005104 NDC 636 RC Facility Outpatient 80 ME 54 54 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 methylPREDNISolone (DEPO-MEDROL) 80MG J1040 HCPCS 9347501 NDC 636 RC Facility Outpatient 80 ME 89 89 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 methylPREDNISolone (DEPO-MEDROL) 80MG J1040 HCPCS 7000724 CDM 636 RC Facility Outpatient 89 44.5 64.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35 78 TESTOSTERONE (DEPO) IM 10ML 200MG/1ML J1071 HCPCS 7001035 CDM 636 RC Facility Outpatient 200 ME 696.85 348.42 508.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.55 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 369.33 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.55 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 613.23 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.55 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 280.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.48 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 529.61 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.55 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.55 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274 613 DExamethASONE (DECADRON) VIAL 4MG J1100 HCPCS 63323016501 NDC 636 RC Facility Outpatient 4 ME 21 21 73 15.33 15.33 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 11.13 1 through 10 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 18 DExamethASONE (DECADRON) VIAL 10MG J1100 HCPCS 63323050601 NDC 636 RC Facility Outpatient 10 ME 21 21 73 15.33 15.33 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 11.13 1 through 10 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 18 DIGOXIN (LANOXIN) INJECTION 2ML 0.5 MG J1160 HCPCS 641141031 NDC 636 RC Facility Outpatient 0.2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 DIGOXIN (LANOXIN) INJECTION 2ML 0.5 MG J1160 HCPCS 7000682 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PHENYTOIN (DILanTIN) VIAL 2ML 100MG J1165 HCPCS 641049325 NDC 636 RC Facility Outpatient 50 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PHENYTOIN (DILanTIN) INJ 5ML 250MG J1165 HCPCS 641255541 NDC 636 RC Facility Outpatient 1000 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PHENYTOIN SODIUM IV SOLUTION 50MG/1ML J1165 HCPCS 7002297 CDM 636 RC Facility Outpatient 50 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 HYDROMORphone (DILauDID) INJ 1ML 2MG J1170 HCPCS 7000640 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 diphenhydrAMINE (BENADRYL) INJ 1ML 50MG J1200 HCPCS 641037625 NDC 637 RC Facility Outpatient 50 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 DOBUTamine IV SOLN 250MG/D5W 250ML J1250 HCPCS 7001124 CDM 636 RC Facility Outpatient 1000 UN 54 27 39.42 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.62 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 47 DOPamine IV SOLN 400MG/D5W 250ML J1265 HCPCS 338100702 NDC 636 RC Facility Outpatient 400 ME 80 80 58.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 EPTIFIBATIDE (INTEGRILIN)SOLN 100ML 75MG J1327 HCPCS 85113601 NDC 636 RC Facility Outpatient 75 ME 2177 2177 1589.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 857.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1153.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 900.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1915.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1741.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 874.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1741.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1654.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 857 1915 EPTIFIBATIDE (INTEGRILIN)VIAL 10ML 20MG J1327 HCPCS 85117701 NDC 636 RC Facility Outpatient 20 ME 650 650 474.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 344.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 572 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 520 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 520 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 494 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 256 572 EPTIFIBATIDE (INTEGRILIN)SOLN 100ML 75MG J1327 HCPCS 7000704 CDM 636 RC Facility Outpatient 2177 1088.5 1589.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 857.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1153.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 900.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1915.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1741.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 874.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1741.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1654.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1001.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 857 1915 ERTAPENEM IVPB 1 GRAM / 100 ML J1335 HCPCS 7004841 CDM 636 RC Facility Outpatient 1 GM 231 115.5 168.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 703.84 703.84 703.84 1 through 10 Percent of Total Billed Charges 91.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 203 ERTAPENEM IVPB 1 GRAM / 100 ML J1335 HCPCS 7004841 CDM 636 RC Facility Outpatient 531 265.5 387.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 703.84 703.84 703.84 1 through 10 Percent of Total Billed Charges 209.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 219.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 467.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 424.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 424.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 244.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209 467 ESTRADIOL (DELESTROGEN) IN OIL INJ 20MG J1380 HCPCS 7002261 CDM 636 RC Facility Outpatient 20 ME 120 60 87.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 ETHANOLAMINE (ETHAMOLIN) 5% INJECTION J1430 HCPCS 67871479006 NDC 636 RC Facility Outpatient 1 UN 364 364 265.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 320.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 291.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 291.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 276.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143 320 ETANERCEPT (ENBREL) 1ML SYRINGE 50MG J1438 HCPCS 58406043504 NDC 636 RC Facility Outpatient 50 ME 1751 1751 1278.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 689.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 928.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 724.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1540.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 703.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1330.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 689 1540 ETANERCEPT (ENBREL) 1ML SYRINGE 50MG J1438 HCPCS 7000668 CDM 636 RC Facility Outpatient 1751 875.5 1278.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 689.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 928.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 724.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1540.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 703.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1400.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1330.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 689 1540 INJECTAFER INTRAVENOUS SOLUTION 50MG/1ML J1439 HCPCS 7005586 CDM 636 RC Facility Outpatient 750 ME 5210 2605 3803.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2396.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2052.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2761.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2396.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2155.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4584.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4168 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2396.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2093.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4168 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3959.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2396.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2396.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2052 4584 FILGRASTIM (NEUPOGEN) VIAL 480MCG J1442 HCPCS 7001180 CDM 636 RC Facility Outpatient 480 UN 1664 832 1214.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 765.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 655.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 881.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 765.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 688.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1464.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1331.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 765.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 668.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1331.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1264.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 765.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 765.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 655 1464 FLUCONAZOLE (DIFLUCAN) 200MG/100ML IV J1450 HCPCS 70655000210 NDC 636 RC Facility Outpatient 200 ME 122 122 89.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 107 FLUCONAZOLE (DIFLUCAN) 400MG/200ML IV J1450 HCPCS 70655008810 NDC 636 RC Facility Outpatient 400 ME 751 751 548.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 295.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 398.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 310.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 660.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 600.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 600.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 570.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 345.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 295 660 GAMMAGARD 10GM INJECTION J1566 HCPCS 7001088 CDM 636 RC Facility Outpatient 10 GM 2781 1390.5 2030.13 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1279.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1095.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1473.93 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1279.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1150.5 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2447.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2224.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1279.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1117.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2224.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2113.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1279.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1279.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1095 2447 GENTAMICIN SULFATE INJ 80MG/2ML J1580 HCPCS 63323001002 NDC 250 RC Facility Outpatient 80 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 GENTAMICIN INJECTION 2ML 20MG J1580 HCPCS 63323051302 NDC 250 RC Facility Outpatient 10 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 GENTAMYCIN 80MG/NS 50ML J1580 HCPCS 7000918 CDM 250 RC Facility Outpatient 80 ME 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 GENTAMICIN IN NS IVPB 50ML 80MG J1580 HCPCS 7001195 CDM 250 RC Facility Outpatient 80 ME 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 GENTAMICIN 40MG/ML INJECTION J1580 HCPCS 7005021 CDM 636 RC Facility Outpatient 40 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 GLUCAGON EMERGENCY KIT 1MG J1610 HCPCS 597026010 NDC 636 RC Facility Outpatient 1 ME 515 515 375.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 453.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 412 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 412 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 391.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 226.6 226.6 226.6 1 through 10 Percent of Total Billed Charges 236.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202 453 HALOPERIDOL LACTATE (HALdol)INJ 1ML 5MG J1630 HCPCS 10147091101 NDC 636 RC Facility Outpatient 5 ME 31 31 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 13.64 13.64 13.64 1 through 10 Percent of Total Billed Charges 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 HALOPERIDOL DECANOATE IM SUSP 1ML 50MG J1631 HCPCS 7004849 CDM 636 RC Facility Outpatient 50 ME 296 148 216.08 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156.88 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 224.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116 260 HEparIN 100 UNITS/ML VIAL 30ML J1642 HCPCS 641244345 NDC 636 RC Facility Outpatient 100 UN 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 HEPARIN FLUSH 100U/ML 5ML J1642 HCPCS 64253033335 NDC 636 RC Facility Outpatient 100 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 "HEPARIN 25,000 UNITS/250ML PREMIX IV" J1644 HCPCS 409765062 NDC 636 RC Facility Outpatient 100 UN 34 34 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 18.02 18.02 1 through 10 Percent of Total Billed Charges 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 71.28 12.42 228.96 1 through 10 Percent of Total Billed Charges 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 "HEparIN 5,000 UNITS/ML VIAL 1ML" J1644 HCPCS 63323026201 NDC 636 RC Facility Outpatient 5000 UN 27 27 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 18.02 18.02 1 through 10 Percent of Total Billed Charges 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 71.28 12.42 228.96 1 through 10 Percent of Total Billed Charges 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 HEPARIN SODIUM INJ 0.5ML 5000 UNIT J1644 HCPCS 7004810 CDM 636 RC Facility Outpatient 0.5 ML 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 18.02 18.02 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 71.28 12.42 228.96 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 "HEPARIN SODIUM INJ 1ML 5,000 UNIT" J1644 HCPCS 7004835 CDM 636 RC Facility Outpatient 5000 UN 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 18.02 18.02 1 through 10 Percent of Total Billed Charges 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 71.28 12.42 228.96 1 through 10 Percent of Total Billed Charges 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 LOVENOX INJECTION 120MG/0.8ML {120MG/0.8 J1650 HCPCS 7001012 CDM 636 RC Facility Outpatient 120 ME 279 139.5 203.67 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 147.87 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 245.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 223.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 223.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109 245 FONDAPARINUX SODIUM (ARIXTRA) INJ 10 MG J1652 HCPCS 67457059500 NDC 636 RC Facility Outpatient 10 ME 499 499 364.27 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 264.47 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 439.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 399.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 379.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 439 HYDROCORTISONE (SOLU-CORTEF) INJ 500MG J1720 HCPCS 9001612 NDC 636 RC Facility Outpatient 500 ME 112 112 81.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 98 HYDROcortISONE (SOLU-CORTEF)INJ 100MG J1720 HCPCS 9082501 NDC 636 RC Facility Outpatient 100 ME 24 24 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 HYDROcortISONE (SOLU-CORTEF)INJ 100MG J1720 HCPCS 7000728 CDM 636 RC Facility Outpatient 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 INFLIXIMAB (REMICADE) INJECTION 100MG J1745 HCPCS 57894003001 NDC 636 RC Facility Outpatient 100 ME 4785 4785 3493.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2201.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1885.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2536.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2201.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1979.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4210.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3828 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2201.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1923 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3828 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3636.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2201.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2201.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1885 4210 "REMICADE IV PWD FOR SOLN 100MG {100MG, P" J1745 HCPCS 7001138 CDM 636 RC Facility Outpatient 100 ME 2472 1236 1804.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1137.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 973.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1310.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1137.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1022.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2175.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1977.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1137.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 993.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1977.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1878.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1137.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1137.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 973 2175 IRON DEXTRAN INFUS(DEXFERRUM)100MG/2ML J1750 HCPCS 517023410 NDC 636 RC Facility Outpatient 100 ME 232 232 169.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 185.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 204 IRON DEXTRAN (INFED) IV TEST DOSE 25MG J1750 HCPCS 52544093102 NDC 636 RC Facility Outpatient 25 ME 195 195 142.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 IRON DEXTRAN (INFED) IV TEST DOSE 25MG J1750 HCPCS 7000702 CDM 636 RC Facility Outpatient 195 97.5 142.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 89.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 171 IRON DEXTRAN (INFED) INJ 2ML 100MG J1750 HCPCS 7004883 CDM 636 RC Facility Outpatient 100 ME 149 74.5 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 131 VENOFER(IRON SUCROSE) INJ 200MG J1756 HCPCS 7002530 CDM 636 RC Facility Outpatient 200 ME 500 250 365 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 440 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 400 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 425 425 425 1 through 10 Percent of Total Billed Charges 53 220 220 220 1 through 10 Percent of Total Billed Charges 230 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197 440 INDERAL (PROPRANOLOL) INTRA SOLN 1MG/1ML J1800 HCPCS 7002290 CDM 636 RC Facility Outpatient 1 ME 55 27.5 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 INSULIN REGULAR HUMAN 100 UNITS/ML J1815 HCPCS 169183311 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN NPH VIAL (NOVOLIN N) U100 10ML J1815 HCPCS 169183311 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN 70/30 NPH/REG 100UNITS/ML J1815 HCPCS 169183711 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 NOVOLOG MIX 70/30 J1815 HCPCS 169368512 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN NPH HUMAN RECOMB (HUMULIN N) J1815 HCPCS 2831501 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN GLARGINE (LanTUS) 100 UNITS/ML J1815 HCPCS 88222033 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 NOVOLOG MIX 70/30 J1815 HCPCS 7000760 CDM 250 RC Facility Outpatient 2 1 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN NPH VIAL (NOVOLIN N) U100 10ML J1815 HCPCS 7000761 CDM 250 RC Facility Outpatient 2 1 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 HUMALOG SUBQ KWIKPEN 100U/1ML J1815 HCPCS 7004973 CDM 250 RC Facility Outpatient 100 UN 284 142 207.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111 249 NOVOLOG FLEXPEN SUBQ SOLN 100U/1ML J1815 HCPCS 7004974 CDM 250 RC Facility Outpatient 1 UN 262 131 191.26 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 89.6 89.6 89.6 1 through 10 Percent of Total Billed Charges 120.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45 12 45 1 through 10 Percent of Total Billed Charges 120.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 230 INSULIN ASPARTATE (NOVOLOG) 100 UNIT/ML J1817 HCPCS 169750111 NDC 250 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 INSULIN ASPARTATE (NOVOLOG) 100 UNIT/ML J1817 HCPCS 7000625 CDM 250 RC Facility Outpatient 2 1 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 KETOROLAC (TORADOL) INJECTION 30MG J1885 HCPCS 63323016201 NDC 636 RC Facility Outpatient 30 ME 21 21 73 11.13 11.13 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 13 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 0.51 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 9.66 9.24 17.85 1 through 10 Percent of Total Billed Charges 53 11.13 9.24 11.13 47 Percent of Total Billed Charges 53 9 8.71 9 1 through 10 Percent of Total Billed Charges 8 16 KETOROLAC (TORADOL) INJECTION 60MG J1885 HCPCS 63323016202 NDC 636 RC Facility Outpatient 60 ME 21 21 73 11.13 11.13 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 13 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 0.51 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 9.66 9.24 17.85 1 through 10 Percent of Total Billed Charges 53 11.13 9.24 11.13 47 Percent of Total Billed Charges 53 9 8.71 9 1 through 10 Percent of Total Billed Charges 8 16 KETOROLAC (TORADOL) INJECTION 15MG J1885 HCPCS 7002225 CDM 636 RC Facility Outpatient 15 ME 20 10 73 11.13 11.13 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 13 Percent of Total Billed Charges 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 0.51 100 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 9.66 9.24 17.85 1 through 10 Percent of Total Billed Charges 53 11.13 9.24 11.13 47 Percent of Total Billed Charges 53 9 8.71 9 1 through 10 Percent of Total Billed Charges 7 16 FuroSEMIDE (LASIX) VIAL 2ML 20MG J1940 HCPCS 36000028225 NDC 636 RC Facility Outpatient 20 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 FuroSEMIDE (LASIX) ORAL SOLN 4ML 40MG J1940 HCPCS 409610204 NDC 250 RC Facility Outpatient 40 ME 53 53 38.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 46 FuroSEMIDE (LASIX) VIAL 4ML 40MG J1940 HCPCS 63323028004 NDC 636 RC Facility Outpatient 40 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FUROSEMIDE (LASIX) INJ 10MG/ML 2ML VIAL J1940 HCPCS 7005038 CDM 636 RC Facility Outpatient 10 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LEVOFLOXACIN (LEVAQUIN) INJ 750MG/30ML J1956 HCPCS 7004985 CDM 636 RC Facility Outpatient 750 ME 263 131.5 191.99 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.39 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 210.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 231 LIDOCAINE (XYLOCAINE) SYR 5ML 100MG J2001 HCPCS 409132305 NDC 636 RC Facility Outpatient 20 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LIDOCAINE HCL EPIDURAL SOLN 1% J2001 HCPCS 7005039 CDM 636 RC Facility Outpatient 1 UN 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LINEZOLID (ZYVOX) IVPB 300ML 600mg J2020 HCPCS 7001014 CDM 636 RC Facility Outpatient 600 ME 690 345 503.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 271.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 365.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 607.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 277.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 552 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 524.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 271 607 LORAZEPAM (ATIVAN) INJ 2MG / 1ML J2060 HCPCS 641604401 NDC 636 RC Facility Outpatient 2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 9.24 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MANNITOL INJECTION 25% (12.5GRAM) 50ML J2150 HCPCS 7004862 CDM 636 RC Facility Outpatient 25 UN 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPERIDINE (DEMEROL) INJECTION 25MG J2175 HCPCS 409117630 NDC 250 RC Facility Outpatient 25 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPERIDINE (DEMEROL) VIAL 75MG J2175 HCPCS 409117930 NDC 250 RC Facility Outpatient 75 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPERIDINE (DEMEROL) INJECTION 75MG J2175 HCPCS 409117930 NDC 636 RC Facility Outpatient 75 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEPERIDINE (DEMEROL) INJECTION 50MG J2175 HCPCS 641605225 NDC 250 RC Facility Outpatient 50 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPERIDINE (DEMEROL) VIAL 75MG J2175 HCPCS 7000732 CDM 250 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPERIDINE (DEMEROL) INJECTION 75MG J2175 HCPCS 7000733 CDM 636 RC Facility Outpatient 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEROPENEM INJECTION 500MG J2185 HCPCS 7005488 CDM 636 RC Facility Outpatient 500 ME 36 18 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 MIDAZOLAM (VERSED) INJECTION 2ML 2MG J2250 HCPCS 409230517 NDC 636 RC Facility Outpatient 2 ME 29 29 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 MIDAZOLAM (VERSED) INJECTION 1ML 5MG J2250 HCPCS 409230801 NDC 636 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MIDAZOLAM (VERSED) INJECTION 1ML 5MG J2250 HCPCS 7000750 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MORphine SULFATE INJ 1ML 2MG J2270 HCPCS 409189001 NDC 636 RC Facility Outpatient 2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 9.66 1 through 10 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 16 MORphine SULFATE INJ 1ML 10MG J2270 HCPCS 63323045101 NDC 636 RC Facility Outpatient 10 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 9.66 1 through 10 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 16 MORphine SULFATE INJ 1ML 10MG J2270 HCPCS 7000748 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 9.24 9.24 9.66 1 through 10 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 16 MORphine SULFATE INJ 1ML 4MG J2274 HCPCS 409189101 NDC 636 RC Facility Outpatient 4 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 35.32 35.32 35.32 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.48 18.48 18.48 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 NALBUPHINE (NUBAIN) VIAL 1ML 10MG J2300 HCPCS 409146301 NDC 636 RC Facility Outpatient 10 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 NALBUPHINE (NUBAIN) VIAL 100MG/10ML J2300 HCPCS 409146401 NDC 636 RC Facility Outpatient 100 ME 80 80 58.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 NALBUPHINE (NUBAIN) INJ 1ML 20MG J2300 HCPCS 409146501 NDC 636 RC Facility Outpatient 20 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 NALBUPHINE (NUBAIN) VIAL 100MG/10ML J2300 HCPCS 7000741 CDM 636 RC Facility Outpatient 80 40 58.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 NALBUPHINE (NUBAIN) VIAL 1ML 10MG J2300 HCPCS 7000742 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 NALBUPHINE HCL INJ SOLN 20MG/1ML J2300 HCPCS 7002206 CDM 636 RC Facility Outpatient 20 ME 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 NALoXONE (NARCAN) INJECTION 1ML 0.4MG J2310 HCPCS 409178269 NDC 636 RC Facility Outpatient 0.4 ME 37 37 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 NALOXONE HCL (NARCAN) INJ 2ML 2MG J2310 HCPCS 7002190 CDM 636 RC Facility Outpatient 1 ME 107 53.5 78.11 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.71 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 94 OCETREOTIDE(SANDOSTATIN) 0.2MG/ML 5ML J2354 HCPCS 55390016301 NDC 636 RC Facility Outpatient 1 ME 1105 1105 806.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 457.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 972.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 884 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 884 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 839.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435 972 OCETREOTIDE(SANDOSTATIN) 0.2MG/ML 5ML J2354 HCPCS 7000833 CDM 636 RC Facility Outpatient 1105 552.5 806.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 585.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 457.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 972.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 884 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 444.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 884 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 839.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 508.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435 972 OCTREOTIDE (SANDOSTATIN) 200MCG/1ML INJ J2354 HCPCS 7004884 CDM 636 RC Facility Outpatient 0.2 ME 805 402.5 587.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 370.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 426.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 370.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 708.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 644 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 370.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 323.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 644 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 611.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 370.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 370.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 317 708 PHENYLEPHRINE(NEOSYNEPHRINE)1ML 10MG J2370 HCPCS 641614225 NDC 636 RC Facility Outpatient 10 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 ONDANSETRON (ZOFRAN) INJ 2MG/ML J2405 HCPCS 55150012502 NDC 636 RC Facility Outpatient 4 ME 21 21 73 61.32 22.26 61.32 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 11.13 9.24 18.48 15 Percent of Total Billed Charges 53 8.71 8.71 8.71 1 through 10 Percent of Total Billed Charges 8 16 PAMIDRONATE (AREDIA) INJ 90 MG J2430 HCPCS 61703032418 NDC 636 RC Facility Outpatient 3 ME 97 97 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 PAMIDRONATE INJECTION 30MG J2430 HCPCS 7004901 CDM 636 RC Facility Outpatient 30 ME 97 48.5 70.81 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.41 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 85 PEN G BENZ/PENG PROCAINE VIAL 1.2MMU/2ML J2510 HCPCS 60793013110 NDC 636 RC Facility Outpatient 2 ML 140 140 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 PEN G BENZ/PENG PROCAINE VIAL 1.2MMU/2ML J2510 HCPCS 7000770 CDM 636 RC Facility Outpatient 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 "PENICILLIN G POT VIAL 5,000,000 UNIT" J2540 HCPCS 49052083 NDC 636 RC Facility Outpatient 5 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 "PENICILLIN G POT VIAL 5,000,000 UNIT" J2540 HCPCS 7000653 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PIPERACILLIN/TAZO (ZOSYN) IVPB 3.375GM J2543 HCPCS 60505615704 NDC 636 RC Facility Outpatient 3.3 GM 123 123 89.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 541.2 303.6 541.2 1 through 10 Percent of Total Billed Charges 56.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 108 PIPERACILLIN/TAZO(ZOSYN) IVPB 2.25 GM J2543 HCPCS 7002227 CDM 636 RC Facility Outpatient 2.2 GM 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 541.2 303.6 541.2 1 through 10 Percent of Total Billed Charges 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 PROMETHAZINE IM INJ 25MG J2550 HCPCS 641149535 NDC 636 RC Facility Outpatient 25 ME 21 21 73 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.01 3.01 3.01 1 through 10 Percent of Total Billed Charges 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 3.01 100 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PhenoBARBITAL SODIUM VIAL 1ML 65MG J2560 HCPCS 641047625 NDC 636 RC Facility Outpatient 65 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PhenoBARBITAL SODIUM VIAL 1ML 130MG J2560 HCPCS 641047725 NDC 636 RC Facility Outpatient 130 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 PhenoBARBITAL SODIUM VIAL 1ML 130MG J2560 HCPCS 7000763 CDM 636 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 PhenoBARBITAL SODIUM VIAL 1ML 65MG J2560 HCPCS 7000764 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 OXYTOCIN (PITOCIN) INJ 1ML 10U J2590 HCPCS 7004888 CDM 636 RC Facility Outpatient 10 UN 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 PROPOFOL (DIPRIVAN) 10MG/ML 100ML J2704 HCPCS 7003743 CDM 250 RC Facility Outpatient 1000 ME 187 93.5 136.51 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.11 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73 164 *NEOSTIGMINE 1MG/ML VIAL 10ML J2710 HCPCS 63323038310 NDC 636 RC Facility Outpatient 1 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 *NEOSTIGMINE 1MG/ML VIAL 10ML J2710 HCPCS 7000849 CDM 636 RC Facility Outpatient 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 NEOSTIGMINE(PROSTIGMINE) 0.5MG/ML 10ML J2710 HCPCS 7005555 CDM 636 RC Facility Outpatient 0.5 ME 514 257 375.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 272.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 452.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 206.57 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 411.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 390.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 236.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202 452 PROTAMINE SULFATE VIAL 5ML 50MG J2720 HCPCS 7001188 CDM 636 RC Facility Outpatient 50 ME 140 70 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 METOcloPRAMIDE (REGLAN) INJ 2ML 10MG J2765 HCPCS 409341401 NDC 636 RC Facility Outpatient 10 ME 21 21 73 15.33 15.33 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 METOCLOPRAMIDE HCL INJ SOLN 5MG/1ML J2765 HCPCS 7002220 CDM 636 RC Facility Outpatient 5 ME 20 10 73 15.33 15.33 15.33 1 through 10 Percent of Total Billed Charges 53 11.13 11.13 11.13 1 through 10 Percent of Total Billed Charges 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 RANITIDINE (ZANTAC) INJECTION 2ML 50MG J2780 HCPCS 7004957 CDM 636 RC Facility Outpatient 50 ME 22 11 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 MICRHOGAM ULTRA-FILTERED(RHOGAM) INJ SOL J2788 HCPCS 7001044 CDM 636 RC Facility Outpatient 50 UN 190 95 138.7 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.7 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 167 MEthOcarBAMOL (ROBAXIN) 1000MG INJ 10ML J2800 HCPCS 517182510 NDC 636 RC Facility Outpatient 1000 ME 86.2 86.2 62.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.65 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.65 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.86 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.65 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.51 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.65 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.65 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 75 SOD FERRIC GLUC(FERRLECIT)VIAL 125MG J2916 HCPCS 591014926 NDC 636 RC Facility Outpatient 62.5 ME 200 200 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 SOD FERRIC GLUC(FERRLECIT)VIAL 125MG J2916 HCPCS 7000701 CDM 636 RC Facility Outpatient 200 100 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 SOLUMEDROL 40MG INJ J2920 HCPCS 9003928 NDC 636 RC Facility Outpatient 40 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 SOLUMEDROL 1GM INJ J2930 HCPCS 9069801 NDC 250 RC Facility Outpatient 1 GM 98 98 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 methylPREDNISolone(SOLUMEDROL) VL 1GM J2930 HCPCS 9069801 NDC 250 RC Facility Outpatient 1 GM 98 98 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 SOLUMEDROL 500MG INJ J2930 HCPCS 9075801 NDC 250 RC Facility Outpatient 500 ME 70 70 51.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27 61 methylPREDNISolone(SOLUMEDROL) VL 500MG J2930 HCPCS 9075801 NDC 250 RC Facility Outpatient 500 ME 53 53 38.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 46 methylPREDNISolone(SOLUMEDROL) VL 500MG J2930 HCPCS 7000726 CDM 250 RC Facility Outpatient 53 26.5 38.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 46 methylPREDNISolone(SOLUMEDROL) VL 1GM J2930 HCPCS 7000727 CDM 250 RC Facility Outpatient 98 49 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 ALTEPLASE (CATHFLO) INJ 2 MG J2997 HCPCS 50242004164 NDC 636 RC Facility Outpatient 2 ME 625 625 456.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 331.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 258.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 550 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 500 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 251.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 500 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 475 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 287.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246 550 ALTEPLASE (ACTIVASE) INJ 100 MG J2997 HCPCS 50242008527 NDC 636 RC Facility Outpatient 100 ME 13071 13071 9541.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5149.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6927.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5407.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11502.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5252.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9933.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5149 11502 ALTEPLASE (ACTIVASE) INJ 100 MG J2997 HCPCS 7000658 CDM 636 RC Facility Outpatient 13071 6535.5 9541.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5149.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6927.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5407.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11502.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5252.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10456.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9933.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6012.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5149 11502 ALTEPLASE (ACTIVASE) INJ 50 MG J2997 HCPCS 7005228 CDM 636 RC Facility Outpatient 50 ME 6695 3347.5 4887.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3079.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2637.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3548.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3079.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2769.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5891.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5356 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3079.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2690.59 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5356 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5088.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3079.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3079.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2637 5891 FENTAnyl AMP 2ML 100MCG J3010 HCPCS 409909422 NDC 636 RC Facility Outpatient 0.1 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 FENTAnyl AMP 2ML 100MCG J3010 HCPCS 7000850 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 TENECTEPLASE 50MG KIT J3101 HCPCS 50242012001 NDC 636 RC Facility Outpatient 50 ME 16958 16958 12379.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7800.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6681.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8987.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7800.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7015.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14923.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13566.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7800.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6815.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13566.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12888.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7800.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7800.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6681 14923 TERButAline (BRETHINE) 1MG/ML VIAL 1ML J3105 HCPCS 143974610 NDC 636 RC Facility Outpatient 1 ML 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 TERButAline (BRETHINE) 1MG/ML VIAL 1ML J3105 HCPCS 7000806 CDM 636 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 chlorproMAZINE (THORAZINE) INJ 25MG/1ML J3230 HCPCS 7002241 CDM 636 RC Facility Outpatient 25 ME 47 23.5 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 TYGACIL INTRAVENOUS PWD FOR SOLN 50MG J3243 HCPCS 7005056 CDM 636 RC Facility Outpatient 50 ME 445 222.5 324.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 235.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 391.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 356 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 338.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175 391 TOBRAMYCIN (NEBCIN) INJ 2ML 80MG J3260 HCPCS 63323030602 NDC 636 RC Facility Outpatient 80 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 TRIAMCINOLONE(KENALOG-40) INJ 1ML 40MG J3301 HCPCS 7001029 CDM 636 RC Facility Outpatient 40 ME 50 25 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 DIAzePAM (VALIUM) INJ 10MG/2ML J3360 HCPCS 409127332 NDC 636 RC Facility Outpatient 10 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 DIAzePAM (VALIUM) 50MG/10ML INJ J3360 HCPCS 409321302 NDC 636 RC Facility Outpatient 50 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 DIAZEPAM INJ SOLN 5MG/1ML J3360 HCPCS 7004834 CDM 636 RC Facility Outpatient 5 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 VANCOMYCIN INJECTION 500MG J3370 HCPCS 409653401 NDC 250 RC Facility Outpatient 500 ME 24 24 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 VANCOMYCIN INJECTION 1000 MG J3370 HCPCS 409653501 NDC 250 RC Facility Outpatient 1000 ME 41 41 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 VANCOMYCIN 1 GM NS 250ML J3370 HCPCS 7000919 CDM 250 RC Facility Outpatient 1 GM 37 18.5 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 hydrOXYzine (VISTARIL) INJ 1ML 25 MG J3410 HCPCS 517420125 NDC 636 RC Facility Outpatient 25 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 hydrOXYzine (VISTARIL) INJ 1ML 50 MG J3410 HCPCS 517560125 NDC 636 RC Facility Outpatient 50 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 HYDRoxyZINE (ATARAX) 50MG/ML VIAL 2ML J3410 HCPCS 517560225 NDC 636 RC Facility Outpatient 100 ME 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 hydrOXYzine (VISTARIL) INJ 1ML 25 MG J3410 HCPCS 7000848 CDM 636 RC Facility Outpatient 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 HYDRoxyZINE (ATARAX) 50MG/ML VIAL 2ML J3410 HCPCS 7000855 CDM 636 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 THIAMINE (VITAMIN B1) INJ 100MG/ML J3411 HCPCS 67457019602 NDC 636 RC Facility Outpatient 100 ME 64 64 46.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 33.92 33.92 33.92 1 through 10 Percent of Total Billed Charges 25.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 56 CYANOCOBALAMIN (B12) 1ML INJ 1000MCG J3420 HCPCS 63323004401 NDC 636 RC Facility Outpatient 1000 EA 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MAGNESIUM SULFATE INJ 2ML 1 GM J3475 HCPCS 63323006402 NDC 636 RC Facility Outpatient 4 UN 12 12 73 36.04 36.04 36.04 1 through 10 Percent of Total Billed Charges 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 10.09 10.09 10.09 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 14.96 21.2 1 through 10 Percent of Total Billed Charges 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 MAGNESIUM SULFATE IVPB 50ML 2GRAM J3475 HCPCS 7005058 CDM 636 RC Facility Outpatient 2 GM 34 17 73 36.04 36.04 36.04 1 through 10 Percent of Total Billed Charges 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 10.09 10.09 10.09 1 through 10 Percent of Total Billed Charges 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 14.96 21.2 1 through 10 Percent of Total Billed Charges 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 27 MAGNESIUM SULF IVPB 100ML 1GRAM J3475 HCPCS 7005185 CDM 636 RC Facility Outpatient 1 GM 40 20 73 36.04 36.04 36.04 1 through 10 Percent of Total Billed Charges 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 10.09 10.09 10.09 1 through 10 Percent of Total Billed Charges 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 18.02 14.96 21.2 1 through 10 Percent of Total Billed Charges 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 32 NS 0.9%/KCL 20MEQ IV PREMIX 1000ML J3480 HCPCS 338069104 NDC 250 RC Facility Outpatient 1000 ML 103 103 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 (POTASSIUM CHL) IVPB 100ML 20MEQ J3480 HCPCS 338070548 NDC 250 RC Facility Outpatient 20 UN 28 28 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 POTASSIUM CL(KCL) ORAL SOLN 15ML 20MEQ J3480 HCPCS 338070548 NDC 250 RC Facility Outpatient 20 UN 8 8 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 POTASSIUM CHL(KCL) IVPB 100ML 10MEQ J3480 HCPCS 338070948 NDC 250 RC Facility Outpatient 10 UN 28 28 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 POTASSIUM CL (KCL) INJ 10ML 20MEQ J3480 HCPCS 409665106 NDC 250 RC Facility Outpatient 20 UN 21 21 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 POTASSIUM CL (KCL) INJ 20ML 40MEQ J3480 HCPCS 63323096520 NDC 250 RC Facility Outpatient 40 UN 21 21 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 POTASSIUM CHL(KCL) IVPB 100ML 10MEQ J3480 HCPCS 7000706 CDM 250 RC Facility Outpatient 28 14 73 135.68 135.68 135.68 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 207.35 30.27 207.35 1 through 10 Percent of Total Billed Charges 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 39.16 39.16 39.16 1 through 10 Percent of Total Billed Charges 53 127.73 58.88 136.21 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 ZIPRASIDONE (GEODON) INJECTION 20MG J3486 HCPCS 49392083 NDC 636 RC Facility Outpatient 20 ME 55 55 40.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 48 AMIKACIN SULFATE VIAL 500 MG J3490 HCPCS 23155029041 NDC 250 RC Facility Outpatient 500 ME 27 27 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 21 METRONIDAZOLE GEL 45GM J3490 HCPCS 299382045 NDC 250 RC Facility Outpatient 45 GM 373 373 272.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 197.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 298.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 298.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 283.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 171.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146 298 BUMETANIDE (BUMEX) 0.5MG/2ML INJ J3490 HCPCS 409141204 NDC 636 RC Facility Outpatient 0.2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 BUMETANIDE (BUMEX) 0.25MG/ML VIAL 10ML J3490 HCPCS 409141204 NDC 250 RC Facility Outpatient 250 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 BUPIVACAINE HCL 0.25% VIAL 30ML J3490 HCPCS 409174630 NDC 250 RC Facility Outpatient 50 ML 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 BUPIVACAINE HCL VIAL 0.5% 30ML J3490 HCPCS 409174929 NDC 250 RC Facility Outpatient 30 ML 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 18 METOPROLOL (LOPRESSOR) INJ 5ML 5MG J3490 HCPCS 409177805 NDC 250 RC Facility Outpatient 5 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 PROPOFOL (DIPRIVAN)500MG/50ML VL J3490 HCPCS 409469933 NDC 250 RC Facility Outpatient 1 UN 149 149 108.77 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.97 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.54 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58 119 ETOMIDATE (AMIDATE) VIAL 2MG/ML 20ML J3490 HCPCS 409669502 NDC 250 RC Facility Outpatient 40 ME 48 48 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 38 METRONIDAZOLE (FLAGYL) IVPB 500MG/100ML J3490 HCPCS 409781124 NDC 636 RC Facility Outpatient 500 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 BUPIVACAINE/EPI VIAL 10ML J3490 HCPCS 409904201 NDC 250 RC Facility Outpatient 10 ML 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 BUPIVACAINE/EPI VIAL 30ML J3490 HCPCS 409904202 NDC 250 RC Facility Outpatient 30 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 PHYTONADIONE (VITAMIN K) INJ 10MG J3490 HCPCS 409915801 NDC 250 RC Facility Outpatient 10 ME 85 85 62.05 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.05 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.1 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 68 BUMETANIDE (BUMEX) TABLET 1MG J3490 HCPCS 51079089201 NDC 250 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 6 HEPATITIS B (RECOMBIVAX) VACCINE 0.5ML J3490 HCPCS 58160082111 NDC 250 RC Facility Outpatient 0.5 ML 133 133 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 106 PROPOFOL (DIPRIVAN) 10MG/ML VIAL 20ML J3490 HCPCS 63323026929 NDC 250 RC Facility Outpatient 1 UN 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 FAMOTIDINE (PEPCID) VIAL 2ML 20MG J3490 HCPCS 641602225 NDC 636 RC Facility Outpatient 20 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 HEPATITIS B (RECOMBIVAX) VACCINE 0.5ML J3490 HCPCS 7000696 CDM 250 RC Facility Outpatient 133 66.5 97.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 106 PROPOFOL (DIPRIVAN) 10MG/ML VIAL 20ML J3490 HCPCS 7000776 CDM 250 RC Facility Outpatient 30 15 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 VASOPRESSIN INJ SOLN 20U/1ML J3490 HCPCS 7001019 CDM 250 RC Facility Outpatient 20 UN 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 22 FLUMAZENIL (ROMAZICON) VIAL 5ML 0.5MG J3490 HCPCS 7001059 CDM 250 RC Facility Outpatient 0.5 ME 264 132 192.72 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.92 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 109.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 211.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 211.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104 211 SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 80 J3490 HCPCS 7001154 CDM 250 RC Facility Outpatient 1 UN 14 7 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 11 MORRHUATE SODIUM INJECTION 50MG/ML {50MG J3490 HCPCS 7001172 CDM 250 RC Facility Outpatient 500 ME 452 226 329.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 239.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 361.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 361.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 343.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178 361 ENALAPRILAT IV SOLN 1 ML 1.25MG J3490 HCPCS 7002315 CDM 250 RC Facility Outpatient 1.2 ME 11 5.5 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 8 CLINDAMYCIN PHOSPHATE INJ SOLN 150MG/1ML J3490 HCPCS 7003711 CDM 250 RC Facility Outpatient 150 ME 32 16 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 25 LABETALOL 5MG/1ML VIAL 20ML J3490 HCPCS 7004882 CDM 250 RC Facility Outpatient 5 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 DILTIAZEM (CARDIZEM) INJ 5MG/ML 50MG J3490 HCPCS 7004896 CDM 250 RC Facility Outpatient 50 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 NAFCILLIN / NS 100ML IVPB 2GM J3490 HCPCS 7004900 CDM 250 RC Facility Outpatient 2 GM 147 73.5 107.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 117.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 117 BUMETANIDE (BUMEX) INJ 0.25MG/ML 4ML J3490 HCPCS 7004916 CDM 250 RC Facility Outpatient 1 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 16 CLINDAMYCIN (CLEOCIN) VIAL 900MG J3490 HCPCS 7004940 CDM 250 RC Facility Outpatient 900 ME 27 13.5 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 21 FAMOTIDINE IVPB 50ML 20MG J3490 HCPCS 7004971 CDM 250 RC Facility Outpatient 20 ME 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 22 BUMETANIDE (BUMEX) TABLET 2 MG J3490 HCPCS 7005364 CDM 250 RC Facility Outpatient 2 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 17.66 17.66 17.66 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 6 HEPATITIS B IMMUNE GLOBULIN IM SOLN J3590 HCPCS 7003750 CDM 636 RC Facility Outpatient 1 ML 371 185.5 270.83 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.63 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 326.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 296.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 281.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146 326 SODIUM CHLORIDE 0.9% IV 1000ML J7030 HCPCS 264780000 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 46.45 46.45 46.45 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 3% IV SOLN 500ML J7030 HCPCS 7002700 CDM 258 RC Facility Outpatient 500 ML 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 46.45 46.45 46.45 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% IV SOLN 500ML J7040 HCPCS 338004903 NDC 258 RC Facility Outpatient 500 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% IV SOLN 500ML J7040 HCPCS 7000621 CDM 258 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5%/0.9% NACL IV 1000ML J7042 HCPCS 338008904 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% IV SOLN 250ML J7050 HCPCS 338004902 NDC 258 RC Facility Outpatient 250 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 SODIUM CHLORIDE 0.9% PB 100ML J7050 HCPCS 338004938 NDC 258 RC Facility Outpatient 1 UN 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% MINIBAG PLUS 100ML J7050 HCPCS 338915930 NDC 258 RC Facility Outpatient 100 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.9% MB 250ML J7050 HCPCS 409798302 NDC 258 RC Facility Outpatient 1 UN 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.9% MB 100ML J7050 HCPCS 409798437 NDC 258 RC Facility Outpatient 100 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% IV SOLN 150ML J7050 HCPCS 990798361 NDC 258 RC Facility Outpatient 150 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.9% IV SOLN 150ML J7050 HCPCS 7000784 CDM 258 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.9% IV SOLN 250ML J7050 HCPCS 7000785 CDM 258 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.9% MINIBAG PLUS 100ML J7050 HCPCS 7000814 CDM 258 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5%/WATER IV 1000ML J7060 HCPCS 264751000 NDC 258 RC Facility Outpatient 1 UN 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5%/WATER 500ML J7060 HCPCS 264751010 NDC 258 RC Facility Outpatient 1 UN 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5%/WATER 250ML J7060 HCPCS 338001702 NDC 258 RC Facility Outpatient 250 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 DEXTROSE 5% IV SOLUTION GLASS 500ML J7060 HCPCS 7001067 CDM 258 RC Facility Outpatient 500 ML 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5% IN WATER PB 50ML J7060 HCPCS 7002011 CDM 258 RC Facility Outpatient 50 ML 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 DEXTROSE 5%/LACT RINGERS IV 1000ML J7120 HCPCS 264775100 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.12 23.22 45.12 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 LACTATED RINGERS IV SOLUTION 1000ML J7120 HCPCS 338011704 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 45.12 23.22 45.12 1 through 10 Percent of Total Billed Charges 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 azaTHIOprine (IMURAN) TABLET 50 MG J7500 HCPCS 7001137 CDM 636 RC Facility Outpatient 50 ME 19 9.5 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 AZATHIOPRINE ORAL TABLET 50MG J7500 HCPCS 7004820 CDM 636 RC Facility Outpatient 50 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 methylPREDNISolone DOSE PAK 4MG J7509 HCPCS 603459315 NDC 636 RC Facility Outpatient 4 ME 48 48 35.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 42 prednisoLONE ORAL SOLN 5ML 15MG J7510 HCPCS 50383004224 NDC 636 RC Facility Outpatient 15 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.58 5.58 5.58 1 through 10 Percent of Total Billed Charges 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 prednisoLONE ORAL SOLN 5ML 15MG J7510 HCPCS 7000779 CDM 636 RC Facility Outpatient 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.58 5.58 5.58 1 through 10 Percent of Total Billed Charges 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 "PREDNISOLONE SYR 15MG/5ML {15MG/5ML, SYR" J7510 HCPCS 7003709 CDM 636 RC Facility Outpatient 15 ME 20 10 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.58 5.58 5.58 1 through 10 Percent of Total Billed Charges 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 predniSONE TABLET 10MG J7512 HCPCS 54001720 NDC 636 RC Facility Outpatient 10 ME 8 8 73 11.68 5.84 17.52 1 through 10 Percent of Total Billed Charges 53 8.48 8.48 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.44 6.8 25.44 1 through 10 Percent of Total Billed Charges 53 10.56 8.48 31.68 1 through 10 Percent of Total Billed Charges 53 9.95 9.95 9.95 1 through 10 Percent of Total Billed Charges 3 7 predniSONE TABLET 5MG J7512 HCPCS 63739051810 NDC 636 RC Facility Outpatient 5 ME 8 8 73 11.68 5.84 17.52 1 through 10 Percent of Total Billed Charges 53 8.48 8.48 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.44 6.8 25.44 1 through 10 Percent of Total Billed Charges 53 10.56 8.48 31.68 1 through 10 Percent of Total Billed Charges 53 9.95 9.95 9.95 1 through 10 Percent of Total Billed Charges 3 7 PREDNIsone (DELTASONE)TABLET 20MG J7512 HCPCS 7001042 CDM 636 RC Facility Outpatient 20 ME 8 4 73 11.68 5.84 17.52 1 through 10 Percent of Total Billed Charges 53 8.48 8.48 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.44 6.8 25.44 1 through 10 Percent of Total Billed Charges 53 10.56 8.48 31.68 1 through 10 Percent of Total Billed Charges 53 9.95 9.95 9.95 1 through 10 Percent of Total Billed Charges 3 7 predniSONE TABLET 2.5MG J7512 HCPCS 7002133 CDM 636 RC Facility Outpatient 2.5 ME 8 4 73 11.68 5.84 17.52 1 through 10 Percent of Total Billed Charges 53 8.48 8.48 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.44 6.8 25.44 1 through 10 Percent of Total Billed Charges 53 10.56 8.48 31.68 1 through 10 Percent of Total Billed Charges 53 9.95 9.95 9.95 1 through 10 Percent of Total Billed Charges 3 7 predniSONE ( DELTASONE) TABLET 1MG J7512 HCPCS 7002230 CDM 636 RC Facility Outpatient 1 ME 8 4 73 11.68 5.84 17.52 1 through 10 Percent of Total Billed Charges 53 8.48 8.48 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 25.44 6.8 25.44 1 through 10 Percent of Total Billed Charges 53 10.56 8.48 31.68 1 through 10 Percent of Total Billed Charges 53 9.95 9.95 9.95 1 through 10 Percent of Total Billed Charges 3 7 ACETYLCYSTEINE (MUCOMYST) INH 20% 4 ML J7608 HCPCS 63323069404 NDC 636 RC Facility Outpatient 800 ME 77 77 56.21 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.81 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 67 ACETYLCYSTEINE INH/NEB SOLN 20% J7608 HCPCS 7004934 CDM 636 RC Facility Outpatient 1 UN 65 32.5 47.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 57 ACETYLCYSTEINE INH/NEB SOLN 10% J7608 HCPCS 7004979 CDM 636 RC Facility Outpatient 1 UN 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 ALBUTEROL INH SOL 0.083%/3ML J7613 HCPCS 487950103 NDC 250 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALBUTEROL INH SOL 2.5 MG / 0.5 ML J7613 HCPCS 487950125 NDC 250 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVALBUTEROL (XopENEX) 0.63MG INH 3ML J7614 HCPCS 17478017424 NDC 636 RC Facility Outpatient 3 ML 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 LEVALBUTEROL (XopENEX) 0.63MG INH 3ML J7614 HCPCS 7000827 CDM 636 RC Facility Outpatient 25 12.5 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 BUDESONIDE (PULMICORT) NEB 2ML 0.25MG J7626 HCPCS 93681573 NDC 636 RC Facility Outpatient 0.2 ME 32 32 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 BUDESONIDE (PULMICORT) NEB 2ML 0.5MG J7626 HCPCS 7005198 CDM 636 RC Facility Outpatient 0.5 ME 42 21 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 IPRATROPIUM BROMIDE INH SOLN 0.5MG/2.5ML J7644 HCPCS 487980101 NDC 636 RC Facility Outpatient 0.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 4.24 4.24 4.24 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 13.46 13.46 13.46 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 7.36 7.04 7.36 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 6 ISUPREL INJECTION 0.2MG/ML J7659 HCPCS 7002286 CDM 636 RC Facility Outpatient 0.2 ME 108 54 78.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42 95 DEXTROSE 5%/0.45% NACL IV 1000ML J7799 HCPCS 264761200 NDC 250 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 5%/0.2% NACL IV 1000ML J7799 HCPCS 264761600 NDC 250 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 DEXTROSE 10%/WATER IV 1000ML J7799 HCPCS 338002304 NDC 250 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.45% IV SOLN 500ML J7799 HCPCS 338004303 NDC 250 RC Facility Outpatient 500 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 SODIUM CHLORIDE 0.45% IV 500ML J7799 HCPCS 409798503 NDC 250 RC Facility Outpatient 500 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.45% IV 1000ML J7799 HCPCS 409798509 NDC 250 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.45% IV SOLN 250ML J7799 HCPCS 990798525 NDC 250 RC Facility Outpatient 250 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.45% IV SOLN 250ML J7799 HCPCS 7000781 CDM 250 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.45% IV SOLN 500ML J7799 HCPCS 7000782 CDM 250 RC Facility Outpatient 103 51.5 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 DEXTROSE 10%/WATER IV 1000ML J7799 HCPCS 7000840 CDM 250 RC Facility Outpatient 28 14 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE INJECTION 14.6% 40ML J7799 HCPCS 7001086 CDM 250 RC Facility Outpatient 100 UN 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MANNITOL (OSMITROL) IV 20% 500ML J7799 HCPCS 7005049 CDM 250 RC Facility Outpatient 500 ML 120 60 87.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 105 ACYCLOVIR (ZOVIRAX) TABLET 400MG J8499 HCPCS 7002177 CDM 250 RC Facility Outpatient 400 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACYCLOVIR (ZOVIRAX) TABLET 800MG J8499 HCPCS 7002200 CDM 250 RC Facility Outpatient 800 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CYCLOPHOSPHAMIDE (CYTOXAN) TAB 50MG J8530 HCPCS 7001179 CDM 636 RC Facility Outpatient 50 ME 9 4.5 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DEXAMETHASONE (DECADRON) TABLET 4 MG J8540 HCPCS 7002238 CDM 636 RC Facility Outpatient 4 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 10.56 7.04 10.56 1 through 10 Percent of Total Billed Charges 53 3.68 3.68 3.68 1 through 10 Percent of Total Billed Charges 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METHOTREXATE SODIUM TABLET 2.5MG J8610 HCPCS 54855025 NDC 250 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TAMOXIFEN CITRATE(NOLVADEX) TAB 20MG J8999 HCPCS 378027493 NDC 250 RC Facility Outpatient 20 ME 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 MEGESTROL (MEGACE) TABLET 20MG J8999 HCPCS 51079043420 NDC 250 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEGESTROL (MEGACE) SUSP 40MG/ML 10ML J8999 HCPCS 54354258 NDC 636 RC Facility Outpatient 10 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEUKERAN (CHLORAMBUCIL) TABLET 2MG J8999 HCPCS 76388063525 NDC 250 RC Facility Outpatient 2 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 MEGESTROL (MEGACE) TABLET 40MG J8999 HCPCS 904357161 NDC 250 RC Facility Outpatient 40 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEUKERAN (CHLORAMBUCIL) TABLET 2MG J8999 HCPCS 7000630 CDM 250 RC Facility Outpatient 11 5.5 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 HYDROXYUREA (HYDREA) CAPSULE 500MG J8999 HCPCS 7001002 CDM 250 RC Facility Outpatient 500 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ZOLADEX SUBQ IMPLANT 10.8MG J9202 HCPCS 70002186 CDM 636 RC Facility Outpatient 7088 3544 5174.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3260.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2792.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3756.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3260.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2932.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6237.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5670.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3260.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2848.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5670.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5386.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3260.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3260.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2792 6237 COLLAR CERVICAL LOW CONTOUR LARGE L0120 HCPCS 4001048 CDM 274 RC Facility Outpatient 34 17 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 COLLAR PHILADELPHIA SMALL 3 1/4 L0174 HCPCS 4000085 CDM 274 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 KNEE IMMOBILIZER SMALL L1830 HCPCS 4000194 CDM 274 RC Facility Outpatient 72 36 52.56 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.16 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 63 KNEE IMMOBILIZER X-LARGE L1836 HCPCS 4000196 CDM 274 RC Facility Outpatient 26 13 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.42 34.42 34.42 1 through 10 Percent of Total Billed Charges 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 KNEE IMMOBILIZER MEDIUM L1836 HCPCS 4000197 CDM 274 RC Facility Outpatient 83 41.5 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 34.42 34.42 34.42 1 through 10 Percent of Total Billed Charges 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 SHOULDER IMMOBILIZER LARGE L3670 HCPCS 4006445 CDM 274 RC Facility Outpatient 45 22.5 73 32.85 32.85 32.85 1 through 10 Percent of Total Billed Charges 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 COMFORT FOAM WRIST / THUMB / RT / MEDIUM L3905 HCPCS 40010030 CDM 274 RC Facility Outpatient 58 29 42.34 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.74 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 51 C2 SLIDES CYTOPATH SMR CERV/VAG P3000 HCPCS 5200014 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 V1 SLIDES CYTOPATH SMR CERV/VAG P3000 HCPCS 5200015 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 V2 SLIDES CYTOPATH SMR CERV/VAG P3000 HCPCS 5200016 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 C1 SLIDES CYTOPATH SMR CERV/VAG P3000 HCPCS 5200017 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 CV2 SLIDE CYTOPATH SMR CERV/VAG P3000 HCPCS 5200018 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 CV1 SLIDE CYTOPATH SMR CERV/VAG P3000 HCPCS 5200019 CDM 311 RC Facility Outpatient 38 19 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 BB FEE PRBC LR CMV FREE STOR/PROC P9021 HCPCS 5000644 CDM 390 RC Facility Outpatient 483 241.5 352.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 386.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 386.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 367.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190 425 ALBUMIN IV SOLN 25% 50 ML 12.5 GM P9047 HCPCS 7001148 CDM 636 RC Facility Outpatient 12.5 GM 251 125.5 183.23 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.03 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.46 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 220 PLASMA PROTEIN FRACTION 5% 250ML P9048 HCPCS 13533061325 NDC 636 RC Facility Outpatient 250 ML 85.83 85.83 62.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.53 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.23 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 75 PLASMA PROTEIN FRACTION 5% 250ML P9048 HCPCS 7000857 CDM 636 RC Facility Outpatient 85.83 42.91 62.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.53 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.66 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.23 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33 75 AZITHROMYCIN SUSP 100MG/5ML 15 ML Q0144 HCPCS 69311019 NDC 636 RC Facility Outpatient 100 ME 174 174 127.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 153 ONDANSETRON ODT (ZOFRAN) TABLET 8MG Q0162 HCPCS 7001024 CDM 636 RC Facility Outpatient 8 ME 13 6.5 73 5.84 5.84 5.84 1 through 10 Percent of Total Billed Charges 53 4.24 4.24 8.48 1 through 10 Percent of Total Billed Charges 5.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.15 0.15 0.15 1 through 10 Percent of Total Billed Charges 88 10.93 10.93 10.93 1 through 10 Percent of Total Billed Charges 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 11.05 11.05 11.05 1 through 10 Percent of Total Billed Charges 53 6.89 3.52 7.04 11 Percent of Total Billed Charges 53 5.39 3.31 5.39 1 through 10 Percent of Total Billed Charges 5 10 ONDANSETRON (ZOFRAN) ODT TABLET 4MG Q0162 HCPCS 7002254 CDM 636 RC Facility Outpatient 4 ME 8 4 73 5.84 5.84 5.84 1 through 10 Percent of Total Billed Charges 53 4.24 4.24 8.48 1 through 10 Percent of Total Billed Charges 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.15 0.15 0.15 1 through 10 Percent of Total Billed Charges 88 10.93 10.93 10.93 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100 100 100 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76 11.05 11.05 11.05 1 through 10 Percent of Total Billed Charges 53 6.89 3.52 7.04 11 Percent of Total Billed Charges 53 5.39 3.31 5.39 1 through 10 Percent of Total Billed Charges 3 6 Q-DRYL LIQUID 12.5MG/5ML Q0163 HCPCS 7004836 CDM 636 RC Facility Outpatient 12.5 ME 24 12 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 PROCHLORPERAZINE (COMPAZINE) TAB 5MG Q0164 HCPCS 51079054120 NDC 636 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROCHLORPERAZINE (COMPAZINE) TAB 5MG Q0164 HCPCS 7000778 CDM 636 RC Facility Outpatient 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DROnabiNOL (MARINOL) TABLET 2.5MG Q0167 HCPCS 904674561 NDC 636 RC Facility Outpatient 2.5 ME 27 27 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 28.62 28.62 28.62 1 through 10 Percent of Total Billed Charges 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 hydrOXYzine PAMOATE (VISTARIL) CAP 25MG Q0177 HCPCS 51079007701 NDC 636 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DExamethASONE (DECADRON) TAB 0.5 MG Q0181 HCPCS 54817925 NDC 636 RC Facility Outpatient 0.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ISOVUE 300 PER ML Q9967 HCPCS 6400040 CDM 636 RC Facility Outpatient 5 2.5 3.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 4 ISOVUE 370 PER ML Q9967 HCPCS 6400063 CDM 636 RC Facility Outpatient 5 2.5 3.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 4 METHYLENE BLUE 1% AMPULE 10ML Q9968 HCPCS 17478050410 NDC 636 RC Facility Outpatient 1 UN 27 27 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 FOSPHENYTOIN SODIUM INJ SOLN 75MG/1ML S0078 HCPCS 7002295 CDM 250 RC Facility Outpatient 75 ME 21 10.5 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 EXEMESTANE (AROMASIN) TABLET 25MG S0156 HCPCS 7005217 CDM 250 RC Facility Outpatient 25 ME 8 4 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PANTOPRAZOLE (PROTONIX) IVPB 40MG S0164 HCPCS 7001162 CDM 250 RC Facility Outpatient 78 39 56.94 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.34 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 68 INSULIN GLARGINE (LANTUS) 3ML 100U/1ML S5553 HCPCS 7004975 CDM 250 RC Facility Outpatient 1 UN 242 121 176.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 212.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 193.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95 212 INSULIN DETMIR (LEVEMIR) 100U/1ML 3ML S5561 HCPCS 7004976 CDM 250 RC Facility Outpatient 100 UN 245 122.5 178.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 215 ESMOLOL (BREVIBLOC) 10ML 100MG 10019007587 NDC 250 RC Facility Outpatient 10 ME 98 98 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 DESFLURANE (SUPRANE) (15MIN INTERVALS) 10019064134 NDC 250 RC Facility Outpatient 1 UN 88 88 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 EYE WASH 10119000252 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 EYE IRRIGATING SOLUTION 118ML 10119000252 NDC 637 RC Facility Outpatient 1 UN 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 CHLORPHENIRAMINE TABLET 4MG 10135013324 NDC 637 RC Facility Outpatient 4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BENZOCAINE/TETRACAINE/BUTAMBEN(CETACAINE 10223020101 NDC 250 RC Facility Outpatient 1 UN 40.18 40.18 29.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.14 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.14 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 ANTIPYRINE/BCAINE (AURALGAN) OTIC 10 ML 10310021601 NDC 637 RC Facility Outpatient 1 UN 59 59 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 OXYCODONE/APAP TABLET 5/325 10702018501 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 ANALGESIC RUB 10742000102 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROPRANOLOL (INDERAL) TABLET 10MG 115165901 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 OXYMETAZOLINE (AFRIN) NASAL SPRAY 15ML 11523170201 NDC 637 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 BAZA TOPICAL CREAM 11701004514 NDC 637 RC Facility Outpatient 1 UN 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 MICONAZOLE (MONISTAT) VAG CREAM 11701004514 NDC 637 RC Facility Outpatient 1 UN 41 41 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 MAGNESIUM HYDROXIDE (MOM) SUSP 30ML 121043130 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 diphenhydrAMINE(BENADRYL)ELIX 5ML12.5MG 121048905 NDC 637 RC Facility Outpatient 12.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMIN/COD ELIX (TYLENOL) 5ML 12/120MG 121050416 NDC 637 RC Facility Outpatient 5 ML 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 FERROUS SULFATE ORAL SOLN 330MG/7.5ML 121053005 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DOCUSATE (COLACE) SYRUP 100MG/10ML 121054410 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LACTUlose SYRUP 30ML 121057708 NDC 637 RC Facility Outpatient 10 GM 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GUAifenESIN (ROBITUSSIN) LIQUID 10ML 121063805 NDC 637 RC Facility Outpatient 10 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMINOPHEN (TYLENOL) SOLN 325 MG 121065711 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GUAIFEN/COD (ROBITUSSIN AC) SYRUP 5ML 121077504 NDC 637 RC Facility Outpatient 5 ML 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 SODIUM CIT/CITRIC ACID SOLN 30ML 121119000 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METOcloPRAMIDE(REGLAN)ORAL SOLN 5ML 5MG 121157610 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GUAifenESIN (ROBITUSSIN) LIQUID 5ML 121174405 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MAG / AL HYDROXIDE/SIM (MYLANTA) 10ML 121176030 NDC 637 RC Facility Outpatient 10 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROcoDONE/APAP 7.5-500MG ELIXER 121465515 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 diphenhydrAMINE HCL/ZINC ACET CREAM 12547017162 NDC 637 RC Facility Outpatient 1 UN 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 SODIUM PHOSPHATE(FLEET PHOSPHO SODA)45ML 132010701 NDC 637 RC Facility Outpatient 45 ML 15 15 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 MINERAL OIL (FLEET) ENEMA 133ML 132030140 NDC 637 RC Facility Outpatient 1 UN 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 SODIUM PHOS MB/SODIUM PHOS DB 132080199 NDC 637 RC Facility Outpatient 1 UN 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 PhenoBARBITAL ELIXER UD 5ML 20MG 13517010716 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BELLADONNA/PHENOBARBITAL (DONNATAL) TAB 143114010 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEthOcarBAMOL (ROBAXIN) TABLET 500MG 143129001 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEthOcarBAMOL (ROBAXIN) TABLET 750MG 143129201 NDC 637 RC Facility Outpatient 750 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMIN/BUTALB/CAFFEINE 325/50/40MG TAB 143178701 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GLYCOPYRROLATE (ROBINUL) INJ 2ML 0.4MG 143968101 NDC 250 RC Facility Outpatient 0.4 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LEVOFLOXACIN(LEVAQUIN) IVPB 150ML 750MG 143972001 NDC 258 RC Facility Outpatient 750 ME 259 259 189.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 104.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102 227 ENALAPRILAT (VASOTEC) INJ 1.25 MG/ML 143978710 NDC 250 RC Facility Outpatient 1.2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 CEPHALEXIN (KEFLEX) CAPSULE 500MG 143989701 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMOXICILLIN (AMOXIL) CAPSULE 500 MG 143993901 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALENDRONATE SODIUM (FOSAMAX) 70MG TAB 16252060144 NDC 637 RC Facility Outpatient 70 ME 106 106 77.38 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.18 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 93 HYDROchloroTHIAZIDE TABLET 25MG 16729018301 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BETAMETHASONE VALERATE OINTMENT 0.1% 168003346 NDC 258 RC Facility Outpatient 1 UN 94 94 68.62 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.82 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37 82 VASOLINE TOPICAL JEL 168005321 NDC 637 RC Facility Outpatient 1 UN 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 ZINC OXIDE 20% OINT 28.35 168006231 NDC 637 RC Facility Outpatient 1 UN 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 FLUOCINOLONE (DERMASMOOTH) SCALP OIL 120 168006415 NDC 637 RC Facility Outpatient 1 UN 170 170 124.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 149 EryTHROMYCIN (BASE) 1GM 168007011 NDC 637 RC Facility Outpatient 5 ME 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 CLOTRIMAZOLE/BETAMETH(LOTRISONE)CR 15GM 168025815 NDC 637 RC Facility Outpatient 1 UN 155 155 113.15 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.15 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.29 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 136 CLOTRIMAZOLE/BETAMETH(LOTRISONE)CRM 45GM 168025846 NDC 637 RC Facility Outpatient 1 UN 336 336 245.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 178.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 295.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 154.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132 295 AMCINONIDE CREAM (CYCLOCORT) 60GM 168027860 NDC 637 RC Facility Outpatient 1 UN 205 205 149.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 180 NITROglyCERIN OINT 15GM 168032630 NDC 637 RC Facility Outpatient 1 UN 47 47 34.31 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.91 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.62 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 41 FLUORESCEIN (FLUOR-I-STRIP) OPHTH STRIP 17238090030 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FLUCONAZOLE (DIFLUCAN) TABLET 100MG 172541146 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FLUCONAZOLE (DIFLUCAN) TABLET 150MG 172541211 NDC 637 RC Facility Outpatient 150 ME 73 73 53.29 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.69 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 64 FAMOTIDINE (PEPCID) TABLET 20MG 172572870 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DIGOXIN (LANOXICAP) CAPSULE 0.1 MG 173027255 NDC 637 RC Facility Outpatient 0.1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALBUTErol (PROVENTIL) MDI INHALER 17GM 173068220 NDC 637 RC Facility Outpatient 1 UN 213 213 155.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 187 ADVAIR 100-50 INHALER 14 DOSE 173069604 NDC 637 RC Facility Outpatient 1 UN 466 466 340.18 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.98 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 410.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 187.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 354.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 214.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183 410 ADVAIR DISKUS 250/50 14 DISK 173069604 NDC 258 RC Facility Outpatient 1 UN 465 465 339.45 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 246.45 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 409.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 353.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 183 409 ADVAIR 500-50 INHALER 14 DOSE 173069704 NDC 637 RC Facility Outpatient 1 UN 837 837 611.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 329.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 443.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 346.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 736.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 669.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 669.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 636.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 385.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 329 736 DUTASTERIDE (AVODART) CAP 0.5MG 173071215 NDC 637 RC Facility Outpatient 0.5 ME 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 ROSIGLITAZONE (AVANDIA)TAB 2 MG 173086118 NDC 637 RC Facility Outpatient 2 ME 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 ROSIGLITAZONE (AVANDIA) TAB 4 MG 173086313 NDC 637 RC Facility Outpatient 4 ME 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 VALACYCLOVIR (VALTREX) TABLET 500 MG 173093308 NDC 637 RC Facility Outpatient 500 ME 38 38 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 EryTHROMYCIN OPHTH OINT 5% 3.5GM 17478007035 NDC 637 RC Facility Outpatient 1 UN 98 98 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 LEVALBUTEROL (XopENEX) INH 1.25MG 3ML 17478017424 NDC 637 RC Facility Outpatient 1.2 ME 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 GENTAMICIN SULFATE 0.3% OPHTH DROP 5ML 17478028310 NDC 637 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 GENTAMICIN SULFATE OPHTH OINT 3.5GM 17478028435 NDC 637 RC Facility Outpatient 1 UN 88 88 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 TIMOLOL MALEATE OPHTH SOL 0.5% 17478028810 NDC 637 RC Facility Outpatient 1 UN 88 88 64.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 77 LATANOPROST (XALANTAN) OPHTH SOL 2.5ML 17478062512 NDC 637 RC Facility Outpatient 1 UN 68 68 49.64 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.04 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 59 LIDOCAINE (XYLOCAINE) 2% JELLY 5ML 17478071110 NDC 637 RC Facility Outpatient 5 ML 41 41 29.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.48 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 OFLOXACIN 0.3%(FLOXIN) OPHTH SOL 5ML 17478071310 NDC 637 RC Facility Outpatient 1 UN 248 248 181.04 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 131.44 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 102.6 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 99.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 198.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97 218 CIPROFLOXACIN (CIPRO) OPHTH SOLN 5ML 17478071410 NDC 637 RC Facility Outpatient 1 UN 245 245 178.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.53 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96 215 TIZANIDINE (ZANAFLEX) TAB 4MG 185440051 NDC 637 RC Facility Outpatient 4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (TIAZAC) TABLET 360MG 187261630 NDC 637 RC Facility Outpatient 360 ME 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 NITROPRUSSIDE 50MG/2ML INJ 187430202 NDC 258 RC Facility Outpatient 50 ME 170 170 124.1 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.1 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 149.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.32 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 149 HYOSCYAMINE SULF(LEVSIN) SL TAB 0.125MG 225029515 NDC 637 RC Facility Outpatient 0.1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALPRAZolam (XANAX) TABLET 0.25MG 228202710 NDC 637 RC Facility Outpatient 0.2 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 TEMAZEPAM (RESTORIL) CAP 15MG 228207610 NDC 637 RC Facility Outpatient 15 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 CLONIDINE (CATAPRES) TABLET 0.3MG 228212910 NDC 637 RC Facility Outpatient 0.3 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NIFEdipine (PROCARDIA) CAPSULE 10MG 228249710 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ISOSORBIDE MONONITRATE (MONOKET) TB 20MG 228262011 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 clonazePAM (KLONIPIN) TABLET 0.5MG 228300311 NDC 637 RC Facility Outpatient 0.5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 METFORMIN (GLUCOPHAGE) TABLET 850MG 23155010301 NDC 637 RC Facility Outpatient 850 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 hydrALAZINE (APRESOLINE) TAB 10 MG 23155083201 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LOTEPREDNOL(LOTEMAX) OPHTH 0.5% 5ML 24208029905 NDC 637 RC Facility Outpatient 1 UN 189 189 137.97 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.17 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.19 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 166.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 166 NEO/POLY/HC (CORTISPORIN)OTIC DROP 10ML 24208063562 NDC 637 RC Facility Outpatient 1 UN 159 159 116.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 139.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62 139 SULFACETAMIDE SODIUM 10% OPHTH DROP 15ML 24208067004 NDC 637 RC Facility Outpatient 1 UN 83 83 60.59 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.99 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 73 CYCLOPENTOLATE HCL OPHTH DROP 15ML 24208073506 NDC 637 RC Facility Outpatient 1 UN 32 32 23.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 28 NEO/POLY/DEX (MAXITROL)OPHTH OINT 3.5GM 24208079535 NDC 637 RC Facility Outpatient 1 UN 98 98 71.54 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.94 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.08 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 86 POTASSIUM CHLORIDE (KLOR-CON) TAB 10MEQ 245004101 NDC 637 RC Facility Outpatient 10 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMIODARONE (PACERONE) TABLET 200 MG 245014701 NDC 637 RC Facility Outpatient 200 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 POTASSIUM CHLORIDE (KLOR-CON) TAB 10MEQ 245531701 NDC 637 RC Facility Outpatient 10 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NACL 0.9% PB 50ML 264180031 NDC 258 RC Facility Outpatient 50 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 D5W/0.9% NACL/20MEQ KCL IV SOLN 1000ML 264765200 NDC 258 RC Facility Outpatient 1000 ML 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 HYDROCODONE/ CHLORPHEN(TUSSIONEX) 5ML 27808008601 NDC 637 RC Facility Outpatient 5 ML 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 BISACODYL/MAG CITRATE (EVAC-Q-KWIK) KIT 281029776 NDC 637 RC Facility Outpatient 1 UN 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 NITROglyCERIN OINTMENT 1GM 281032608 NDC 637 RC Facility Outpatient 1 GM 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROCHLOROTHIAZIDE (HCTZ) CAP 12.5MG 29300013001 NDC 637 RC Facility Outpatient 12.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ZALEPLON (SONATA) CAPSULE 5MG 29300013101 NDC 637 RC Facility Outpatient 5 ME 15 15 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 MONTELUKAST (SINGULAR) TABLET 10MG 29300022019 NDC 637 RC Facility Outpatient 10 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LANSOPRAZOLE (PREVACID) 15MG CAP 300154311 NDC 637 RC Facility Outpatient 15 ME 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 QUETIAPINE (SEROQUEL) TABLET 300MG 310027460 NDC 637 RC Facility Outpatient 300 ME 40 40 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 ROSUVASTATIN (CRESTOR) TABLET 10MG 310075190 NDC 637 RC Facility Outpatient 10 ME 25 25 18.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.05 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 22 hydrALAZINE (APPRESOLINE) TAB 100 MG 31722052201 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TorSEMIDE (DEMADEX) TABLET 20MG 31722053101 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VALSARTAN (DIOVAN) TABLET 80MG 33342006310 NDC 637 RC Facility Outpatient 80 ME 15 15 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 SODIUM CHLORIDE 0.9% PB 250ML 338004802 NDC 258 RC Facility Outpatient 1 UN 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% IRRIGATION 1000 ML 338004804 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.9% MB 50ML 338055311 NDC 258 RC Facility Outpatient 50 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.9% PB 50ML 338055311 NDC 258 RC Facility Outpatient 50 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 NACL 0.9% MINIBAG PLUS 50ML 338055311 NDC 258 RC Facility Outpatient 50 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 D5/NS 0.02% KCL 20MEQ IV 1000ML 338066304 NDC 258 RC Facility Outpatient 20 UN 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NITROGLYCERIN 50MG IV SOLN 250ML 338104902 NDC 258 RC Facility Outpatient 50 ME 34 34 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 NITROGLYCERIN 50MG IV SOLN 250ML 338104902 NDC 258 RC Facility Outpatient 250 ML 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 NOHIST-EXT ER (RELCOF)TAB 8MG/2.5MG 35573000410 NDC 637 RC Facility Outpatient 1 EA 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 LEVOFLOXACIN (LEVAQUIN IVPB)100ML 500MG 36000004724 NDC 250 RC Facility Outpatient 500 ME 230 230 167.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 202.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 105.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90 202 NOREPINEPHRINE (LEVOPHED) DRIP 4MG 36000016210 NDC 258 RC Facility Outpatient 4 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PETROLATUM WHITE JELLY 390GM 37205006927 NDC 637 RC Facility Outpatient 1 UN 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 MAGALDRATE/SIMETH (RIOPAN) SUSP 30ML 37205031440 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PSEUDOEPHEDRINE (SUDAFED) TAB 30MG 37205044580 NDC 637 RC Facility Outpatient 30 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SODIUM PHOS (FLEET ENEMA) ADULT 133ML 37205075411 NDC 637 RC Facility Outpatient 133 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BISOPROLOL/HCTZ (ZIAC) TAB 5MG/6.25MG 378050301 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BISOPROLOL FUMARATE (ZEBETA)TAB 10 MG 378052401 NDC 637 RC Facility Outpatient 10 ME 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 CLOniDINE (CATAPRES) PATCH TTS-1 378087199 NDC 637 RC Facility Outpatient 1 UN 180 180 131.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70 158 CLONIDINE (CATAPRES) PATCH TTS-2 378087299 NDC 637 RC Facility Outpatient 1 UN 288 288 210.24 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152.64 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 115.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 132.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113 253 CLONIDINE (CATAPRES) PATCH TTS-3 378087399 NDC 637 RC Facility Outpatient 1 UN 376 376 274.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 199.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 330.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 151.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148 330 DICYCLOMINE (BENTYL) CAPSULE 10MG 378161001 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CETIRIZINE (ZYRTEC) TABLET 10MG 378363701 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METolaZONE (ZAROXOLYN) TAB 2.5MG 378617201 NDC 637 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VERAPAMIL (CALAN) TABLET 100 MG 378620101 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN (NITRO-BID) PATCH 2.5MG 378910293 NDC 637 RC Facility Outpatient 1 UN 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN(NITRO-BID) PATCH 0.2MG/HR 378910493 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN (NITRO-BID) PATCH 0.6MG 378911693 NDC 637 RC Facility Outpatient 1 UN 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 DEXTROSE (GLUTOSE) ORAL GEL 15GM 38396066375 NDC 637 RC Facility Outpatient 15 GM 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 WINTERGREEN OIL 59ML 395166792 NDC 637 RC Facility Outpatient 1 UN 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 CLOVE OIL 395194988 NDC 637 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 PEPPERMINT OIL 395224391 NDC 637 RC Facility Outpatient 1 UN 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 CHERRY SYRUP 30ML 395266216 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMMONIA NEBULE INHALANT 0.33 ML 39822990002 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROcoDONE/APAP (LORTAB) 10/500MG TAB 406036362 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 OXYCOdone (IR) TABLET 5MG 406055262 NDC 637 RC Facility Outpatient 5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 HYDROMORphone (DILauDID) TABLET 2MG 406324301 NDC 637 RC Facility Outpatient 2 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 METHADONE TABLET 5MG 406575523 NDC 637 RC Facility Outpatient 5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 MORphine SULFATE ORAL CONC 20MG/ML 30ML 406800330 NDC 637 RC Facility Outpatient 20 ME 136 136 99.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 72.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 119.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53 119 MORphine (ORAMORPH) ER TABLET 15MG 406831501 NDC 637 RC Facility Outpatient 15 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 MORPHINE (ORAMORPH SR) ER TAB 30MG 406833062 NDC 637 RC Facility Outpatient 30 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 MORphine (MS CONTIN) ER TABLET 60MG 406838001 NDC 637 RC Facility Outpatient 60 ME 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 HYDROMORphone (DILauDID) INJ 1ML 2MG 409131230 NDC 636 RC Facility Outpatient 2 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 EVACUATED CONTAINER 500ML 409161403 NDC 258 RC Facility Outpatient 1 UN 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 BUTORPHANOL (STADOL) VIAL 1ML 2MG 409162601 NDC 250 RC Facility Outpatient 2 ME 39 39 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 HEPARIN 1000 UNITS/ML VIAL 10ML 409272002 NDC 258 RC Facility Outpatient 10000 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LIDOCAINE/EPINEPHRINE 409318202 NDC 250 RC Facility Outpatient 1 UN 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 WATER BACTERIOSTATIC 30ML MDV 409397703 NDC 258 RC Facility Outpatient 30 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LIDOCAINE (XYLOCAINE) 0.5% MDV 50ML 409427501 NDC 250 RC Facility Outpatient 5 ME 29 29 21.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 25 LIDOCAINE HCL 1% (XYLOCAINE) MDV 20ML 409427601 NDC 250 RC Facility Outpatient 20 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 WATER STERILE INJECTION 20ML 409488720 NDC 258 RC Facility Outpatient 10 ML 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 SODIUM CHLORIDE 0.9% SYRINGE 10ML 409488810 NDC 258 RC Facility Outpatient 10 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 FUROSEMIDE (LASIX) VIAL 10ML 100MG 409610210 NDC 250 RC Facility Outpatient 100 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 SODIUM BICARBONATE SYRINGE 50mEq/50ML 409663734 NDC 250 RC Facility Outpatient 50 UN 36 36 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 WATER STERILE FOR IRRIGATION 1000ML 409713909 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 cefTRIAXone (ROCEPHIN) VIAL 500MG 409733801 NDC 250 RC Facility Outpatient 500 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 RINGERS IV SOLN 1000ML 409795309 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SODIUM CHLORIDE 0.45%/KCL 20MEQ 1000ML 409925739 NDC 258 RC Facility Outpatient 1000 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 VENLAFAXINE (EFFEXOR ER) CAP 75MG 41616075983 NDC 637 RC Facility Outpatient 75 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 ACETAMINOPHE/ASA/CAFF (GOODYS) HA POWDER 42037010366 NDC 637 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 METRONIDAZOLE (FLAGYL) TABLET 500MG 42292000120 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEPERIDINE (DEMEROL) TABLET 50MG 42806005030 NDC 637 RC Facility Outpatient 50 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 ACIDOPHILUS/LACTOBACILLUS 43292050022 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 POLYTHYLN GLYCL 3350 (MIRALAX) 17GM 43386031214 NDC 637 RC Facility Outpatient 17 GM 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PENTAZOCINE/NALOXONE (TALWIN-NX) TAB 43386068001 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 DONEPEZIL (ARICEPT) TAB 5 MG 43547027503 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CYCLObenzapRINE (FLEXERIL) TABLET 10MG 43547040010 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMOXICIL/POT CLAV(AUGMENTIN) TAB 500 MG 43598000614 NDC 637 RC Facility Outpatient 500 ME 36 36 26.28 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.08 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.89 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 31 AMOXICIL/K CLAV(AUGMENTIN XR) TAB 1000MG 43598002028 NDC 637 RC Facility Outpatient 1000 ME 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 DIBUCAINE 1% OINT 56GM 45802005003 NDC 637 RC Facility Outpatient 1 UN 39 39 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 GENTAMICIN TOPICAL CREAM 0.1% 15GM 45802005635 NDC 637 RC Facility Outpatient 1 UN 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 MUPIROCIN (BACTROBAN) OINT 22GM 45802011222 NDC 637 RC Facility Outpatient 1 UN 231 231 168.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.56 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 203.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91 203 TRIPLE ANTIBIOTIC OINT 14.17GM 45802014301 NDC 637 RC Facility Outpatient 1 UN 24 24 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 TRIPLE ANTIBIOTIC OINT 1GM 45802014370 NDC 250 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN SPRAY 0.4MG DOSE 45802021001 NDC 637 RC Facility Outpatient 1 UN 215 215 156.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 86.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84 189 KETOCONAZOLE SHAMPOO 45802046564 NDC 258 RC Facility Outpatient 1 UN 141 141 102.93 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.73 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.86 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 ACETAMINOPHEN (TYLENOL) SUPP 650 MG 45802073032 NDC 637 RC Facility Outpatient 650 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMINOPHEN (TYLENOL) SUPP 120 MG 45802073230 NDC 637 RC Facility Outpatient 120 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROMETHAZINE (PHENERGAN) SUPP 12.5MG 45802075830 NDC 637 RC Facility Outpatient 12.5 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 SODIUM POLYSTYRENE SULFONATE BULK 15GM 46287000601 NDC 250 RC Facility Outpatient 15 GM 39 39 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 CLOTRIMAZOLE CREAM 1% 45GM 472022041 NDC 637 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MICONAZOLE 2% VAG CRM 142GM 472073556 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MICONAZOLE(MONISTAT) VAG SUPP 100MG 472173607 NDC 637 RC Facility Outpatient 100 ME 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 ALPRAZolam (XANAX) TABLET 0.5 MG 47335060488 NDC 637 RC Facility Outpatient 0.5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 NITROFURANTOIN (MACROBID) CAPSULE 100MG 47781030301 NDC 637 RC Facility Outpatient 100 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 TETRACYCLINE (SUMYCIN) CAP 250MG 47781050801 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MINERAL OIL ORAL 30ML 48433020230 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RACEMIC EPINEPHRINE INH 2.25% 0.5ML 487590199 NDC 637 RC Facility Outpatient 0.5 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 SODIUM CHLORIDE 0.9% INH SOL 3ML 487930103 NDC 258 RC Facility Outpatient 3 ML 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 TUBERCULIN (PPD) 5TU 0.1ML 49281075221 NDC 250 RC Facility Outpatient 0.1 ML 140 140 102.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 123.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 123 ASPIRIN ENTERIC COATED TABLET 81 MG 49483048112 NDC 637 RC Facility Outpatient 81 ME 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 LAMIVUDINE/ZIDOVUDINE (COMBIVIR) TAB 49702020218 NDC 637 RC Facility Outpatient 1 EA 59 59 43.07 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.27 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 51 DIPYRIDAMOLE/ASPIRIN (AGGRENOX) 200/25MG 49884000702 NDC 637 RC Facility Outpatient 1 UN 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 DOXYcyclINE (VIBRAMYCIN) CAPSULE 100MG 49884072703 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TRAzoDONE (DESYREL) TABLET 50MG 50111043301 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 THEOPHYLLINE (THEO-DUR) E.R TAB 200MG 50111048201 NDC 637 RC Facility Outpatient 200 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FluoXETINE (PROZAC) CAPSULE 20MG 50111064801 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AZITHROMYCIN (ZITHROMAX) TAB 250 MG 50111078751 NDC 637 RC Facility Outpatient 250 ME 38 38 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 ISOSORBIDE MONONITRATE (IMDUR) TAB 30MG 50268045115 NDC 637 RC Facility Outpatient 30 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METFORMIN (GLUCOPHAGE) XR TABLET 500MG 50268053115 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DORZOLAMIDE/TIMOL(COSOPT) OPHTH SLN 5ML 50383023310 NDC 637 RC Facility Outpatient 1 UN 632 632 461.36 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.01 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 334.96 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 261.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 556.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 505.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 253.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 505.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 480.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 290.72 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249 556 BROMFENAC (XIBROM)OPTH 0.09% 50383024971 NDC 637 RC Facility Outpatient 1 UN 725 725 529.25 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 384.25 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 299.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 638 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 580 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 291.36 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 580 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 551 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 333.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285 638 LEVOFLOXACIN (LEVAQUIN) 100MG/5ML SOL 50383028608 NDC 637 RC Facility Outpatient 25 ME 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 CARBOFED DM SYRUP 5ML 50383057516 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FLUTICASONE (FLONASE) NASAL SPRAY 50MCG 50383070016 NDC 637 RC Facility Outpatient 1 UN 146 146 106.58 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 77.38 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 128.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.16 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 128 LIDOCAINE (XYLOCAINE) 2% VISCOUS 100ML 50383077504 NDC 637 RC Facility Outpatient 20 ME 74 74 54.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.16 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 65 SULFA/TMP (SEPTRA) SUSP 5ML 200-40MG 50383082316 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GLYCERIN SUPPOSITORY (ADULT) 50428026926 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMINOPHEN (TYLENOL) TABLET 325 MG 50580049660 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METolaZONE (ZAROXOLYN) TAB 5MG 51079002420 NDC 637 RC Facility Outpatient 5 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CHLORTHALIDONE (HYGROTON) TAB 25MG 51079005801 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FuroSEMIDE (LASIX) TABLET 40MG 51079007320 NDC 637 RC Facility Outpatient 40 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MIRTAZAPINE (REMERON) TABLET 15MG 51079008656 NDC 637 RC Facility Outpatient 15 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PHENYTOIN (DILanTIN) CHEWABLE TAB 50 MG 51079012906 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMITRIPYTLINE (ELAVIL) TABLET 10 MG 51079013120 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BENAZEPRIL (LOTENSIN) TABLET 10MG 51079014501 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BENAZEPRIL (LOTENSIN)TABLET 20MG 51079014601 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 INDOMETHACIN (INDOCIN) CAPSULE 25MG 51079019020 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METRONIDAZOLE (FLAGYL) TABLET 250MG 51079021620 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROPRANOLOL (INDERAL) TABLET 20MG 51079027820 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DIAzePAM (VALIUM) TABLET 5MG 51079028520 NDC 637 RC Facility Outpatient 5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 CLOniDINE (CATAPRES) TABLET 0.1 MG 51079029920 NDC 637 RC Facility Outpatient 0.1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROPOXYPHENE (DARVOCET N-100) TAB 51079032220 NDC 637 RC Facility Outpatient 100 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 chlordiazePOXIDE (LIBRIUM) CAPSULE 5MG 51079037420 NDC 637 RC Facility Outpatient 5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 chlordiazePOXIDE (LIBRIUM) CAPSULE 10MG 51079037520 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LORAZEPAM (ATIVAN) TABLET 0.5MG 51079041720 NDC 637 RC Facility Outpatient 0.5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 TEMAZEPAM (RESTORIL) CAPSULE 30MG 51079041920 NDC 637 RC Facility Outpatient 30 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 TRIAMTERENE/HCTZ (MAXZIDE) TAB 75/50MG 51079043320 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DOxePIN (SINEQUAN) CAPSULE 25MG 51079043720 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVOTHYROXINE (SYNTHROID) TAB 100MCG 51079044220 NDC 637 RC Facility Outpatient 100 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVOTHYROXINE (SYNTHROID) TAB 125MCG 51079044301 NDC 637 RC Facility Outpatient 125 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVOTHYROXINE (SYNTHROID) TAB 150MCG 51079044501 NDC 637 RC Facility Outpatient 150 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 amLODIPine (NORVASC) TABLET 5 MG 51079045156 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 amLODIPine (NORVASC) TABLET 10 MG 51079045201 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SIMVASTATIN (ZOCOR) TABLET 20MG 51079045501 NDC 637 RC Facility Outpatient 20 ME 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 RISPERIDONE (RISPERDAL) TABLET 1MG 51079046220 NDC 637 RC Facility Outpatient 1 ME 24 24 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 chlorproMAZINE (THORAZINE) TAB 25MG 51079051920 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMITRIPTYLINE (ELAVIL) TABLET 100 MG 51079056320 NDC 637 RC Facility Outpatient 100 ME 50 50 36.5 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.5 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 44 THIORIDAZINE (MELLARIL) TABLET 25MG 51079056620 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ATENOLOL (TENORMIN) TABLET 50 MG 51079068401 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LOPERAMIDE (IMODIUM) CAPSULE 2MG 51079069001 NDC 637 RC Facility Outpatient 2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ZOLPIDEM (AMBIEN) TAB 10 MG 51079072520 NDC 637 RC Facility Outpatient 10 ME 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 HALOPERIDOL (HALdol) TABLET 0.5MG 51079073320 NDC 637 RC Facility Outpatient 0.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HALOPERIDOL (HALdol) TABLET 1MG 51079073401 NDC 637 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM (CARDIZEM) TABLET 60MG 51079074620 NDC 637 RC Facility Outpatient 60 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (CARDIZEM) TABLET 90MG 51079074720 NDC 637 RC Facility Outpatient 90 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SUCRALFATE (CARAFATE) TABLET 1GM 51079075320 NDC 637 RC Facility Outpatient 1 GM 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ATENOLOL (TENORMIN) TAB 25 MG 51079075920 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NAPROXEN (NAPROSYN) TABLET 250MG 51079079320 NDC 637 RC Facility Outpatient 250 ME 38 38 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 hydrOXYzine HCL (ATARAX) TAB 25 MG 51079080620 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 glipiZIDE (GLUCOTROL) TABLET 5MG 51079081020 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CAPTOPRIL (CAPOTEN) TABLET 12.5MG 51079086301 NDC 637 RC Facility Outpatient 12.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CAPTOPRIL (CAPOTEN) TABLET 25MG 51079086420 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LAMOTRIGINE (LAMICTAL) TABLET 150MG 51079086501 NDC 637 RC Facility Outpatient 150 ME 31 31 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 glyBURIDE (DIABETA) TABLET 2.5MG 51079087220 NDC 637 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 glyBURIDE (DIABETA) TABLET 5MG 51079087320 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 clonazePAM (KLONOPIN) TABLET 1MG 51079088220 NDC 637 RC Facility Outpatient 1 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 METOcloPRAMIDE HCL (REGLAN) TABLET 5MG 51079088620 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PENTOXIFYLLINE (TRENTAL) TAB 400MG 51079088920 NDC 637 RC Facility Outpatient 400 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PHENYTOIN EXTENDED (DILanTIN) CAP 100MG 51079090520 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TRIAMTERENE/HCTZ (MAXZIDE) 37.5/25MG 51079093520 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TERAZOSIN (HYTRIN) CAPSULE 1MG 51079093620 NDC 637 RC Facility Outpatient 1 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TERAZOSIN (HYTRIN) CAPSULE 5MG 51079093820 NDC 637 RC Facility Outpatient 5 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (CARDIZEM CD) ER CAP 240MG 51079094901 NDC 637 RC Facility Outpatient 240 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM XR (CARDIZEM) CAPSULE 240MG 51079094901 NDC 637 RC Facility Outpatient 240 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DOXAZOSIN (CARDURA) TABLET 2MG 51079095801 NDC 637 RC Facility Outpatient 2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LISINOPRIL (ZESTRIL) TABLET 10MG 51079098220 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 busPIRone HCL (BUSPAR) TABLET 10MG 51079098620 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TRAMADOL (ULTRAM) TABLET 50MG 51079099120 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYOSCYAMINE SUL(LEVBID) ER TAB 0.375MG 51525011501 NDC 637 RC Facility Outpatient 0.3 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CLOBETASOL PROPIONATE 0.05% 15 GM 51672125801 NDC 637 RC Facility Outpatient 1 UN 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 DESONIDE 60GM 0.05% 51672128003 NDC 637 RC Facility Outpatient 1 UN 205 205 149.65 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.77 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.65 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.81 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94.3 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 180 "NystaTIN TOP CREAM 100,000U/GM 30GM" 51672128902 NDC 637 RC Facility Outpatient 1 UN 31 31 22.63 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.43 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.26 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 27 HYDROcortISONE VALERATE 0.2% 60GM 51672129003 NDC 637 RC Facility Outpatient 1 UN 200 200 146 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78 176 IBUPROFEN (MOTRIN) SUSP 5ML 100MG 51672138508 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMINOPHEN (TYLENOL) SUPP 325 MG 51672211602 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NORTRIPTYLINE (PAMELOR) CAPSULE 10MG 51672400101 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GOLYTELY LIQ 4000ML 52268010001 NDC 637 RC Facility Outpatient 4000 ML 80 80 58.4 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.4 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 70 CHLORHEXIDINE GL (HIBICLENS) 473ml 52380127206 NDC 637 RC Facility Outpatient 473 ML 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 POVIDONE-IODINE (BETADINE) SOLN 118ML 52380190504 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ERYTHROMYCIN BASE FILMTAB 250MG 52536018003 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PRIMIDONE (MYSOLINE) TABLET 50MG 527130101 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TERButAline (BRETHINE) TABLET 5MG 527131101 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CODEINE/ASA/BUTALB/CAFF 30/325/50/40 TAB 527131201 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 DIGOXIN (LANOXIN) TABLET 0.125MG 527132401 NDC 637 RC Facility Outpatient 0.1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DIGOXIN (LANOXIN) TABLET 0.25MG 527132501 NDC 637 RC Facility Outpatient 0.2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVOTHYROXINE (SYNTHROID) TAB 112MCG 527134601 NDC 637 RC Facility Outpatient 112 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LUBRIDERM LOTION 177ML 52800048826 NDC 637 RC Facility Outpatient 1 UN 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 CYPROHEPTADINE (PERIACTIN) TABLET 4MG 52817021010 NDC 637 RC Facility Outpatient 4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ARTIFICIAL TEARS (REFRESH) 0.4ML 536138792 NDC 637 RC Facility Outpatient 1 UN 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PYRIDOXINE HCL (VITA B6) 25MG TAB 536440601 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MULTIVITAMIN (MVI) INJ ADULT 10ML 54643564901 NDC 250 RC Facility Outpatient 10 ML 34 34 24.82 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.02 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.66 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 MULTIVITAMIN ORAL SOLN 15ML 54838000980 NDC 637 RC Facility Outpatient 15 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 THERAPEUTIC MULTIVITAMIN LIQUID 5ML 54838000980 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LIDOCAINE 2% (XYLOCAINE) VISCOUS 20ML 54868182701 NDC 637 RC Facility Outpatient 20 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LEVOFLOXACIN (LEVAQUIN) TABLET 500MG 55111028050 NDC 637 RC Facility Outpatient 500 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 LEVOFLOXACIN (LEVAQUIN) TABLET 750MG 55111028130 NDC 637 RC Facility Outpatient 750 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ALLOPURINOL (ZYLOPRIM) TABLET 100 MG 55111072901 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SuMAtripTAN (IMITREX) INJ 0.5ML 6MG 55150017301 NDC 637 RC Facility Outpatient 6 ME 204 204 148.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 84.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 179.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.98 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 93.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 179 hydrOXYzine PAMOATE (VISTARIL) CAP 50MG 555030202 NDC 636 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CLOTRIMAZOLE (MYCELEX) TROCHE 10MG 574010770 NDC 637 RC Facility Outpatient 10 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SODIUM POLY SULF (SPS) SUSP 60ML 15GM 574200202 NDC 637 RC Facility Outpatient 60 ML 39 39 28.47 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.67 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.94 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 34 NEO/BAC/POLY (NEOSPORIN)OPHT OINT 3.5GM 574416035 NDC 637 RC Facility Outpatient 1 UN 221 221 161.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 91.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 194.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87 194 METOPROLOL TAR (LOPRESSOR) TAB 50MG 57664047752 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MULTIVITAMIN W/MINERALS TABLET 57896050101 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MAGNESIUM OXIDE (MAG-OX) TAB 400 MG 57896063412 NDC 637 RC Facility Outpatient 400 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CALCIUM CARB/VITA D (OSCAL-D)TAB 500 MG 57896074201 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ASCORBIC ACID (VITAMIN C) TABLET 250 MG 57896083101 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ASPIRIN ENTERIC COATED TABLET 325 MG 57896092101 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HEPATITIS A VACCINE 58160083701 NDC 250 RC Facility Outpatient 0.5 ML 156 156 113.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 62.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61 137 PAPAIN/UREA OINT (ETHEZYME) 30GM 58177081602 NDC 637 RC Facility Outpatient 1 UN 110 110 80.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 96.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43 96 RENVELA ORAL TABLET 800MG 58468013001 NDC 258 RC Facility Outpatient 800 ME 38 38 27.74 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.97 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.14 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 33 ISOMETHEPT/DICHLORAL/APAP (MIDRIN) CAP 58657040101 NDC 637 RC Facility Outpatient 1 UN 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 CHLORPHENIRAMINE ER CAPSULE 12MG 58809036301 NDC 637 RC Facility Outpatient 12 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VASOLEX (XENADERM) OINTMENT 58980078011 NDC 637 RC Facility Outpatient 1 UN 153 153 111.69 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 81.09 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 134.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 61.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 70.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 134 OXYCOdone (OXYCONTIN) ER TABLET 10MG 59011041020 NDC 637 RC Facility Outpatient 10 ME 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 OXYCOdone (OXYCONTIN) ER TABLET 20MG 59011042020 NDC 637 RC Facility Outpatient 20 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 HYDROcoDONE/ACET(VICODIN)HS 2.5MG/500MG 591038801 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 QUININE SULFATE 260MG TAB 591071501 NDC 637 RC Facility Outpatient 260 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 buPROPion (WELLBUTRIN) XL TAB 150MG 591333130 NDC 637 RC Facility Outpatient 150 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MEMANTINE (NAMENDA) TABLET 10MG 591387544 NDC 637 RC Facility Outpatient 10 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 MEPROBAMATE(EQUANIL) 200MG TAB 591523901 NDC 637 RC Facility Outpatient 200 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARISOPRODOL (SOMA) TABLET 350MG 591551301 NDC 637 RC Facility Outpatient 350 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 ALLOPURINOL (ZYLOPRIM) TABLET 300 MG 591554405 NDC 637 RC Facility Outpatient 300 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MINOXIDIL TABLET 10MG 591564301 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ATENOLOL/CHLORTHALIDONE TAB 50 / 25 MG 591578201 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARBOXYMETHYLCELLULOSE (TEARS) 15ML 59390018513 NDC 637 RC Facility Outpatient 1 UN 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 ALBUTErol/IPRATROP(COMBIVENT) 1 INHALATI 597002402 NDC 637 RC Facility Outpatient 1 UN 1004 1004 732.92 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 532.12 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 415.35 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 883.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 403.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 763.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 461.84 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 395 883 TELMISARTAN (MICARDIS) TAB 40MG 597004037 NDC 637 RC Facility Outpatient 40 ME 14 14 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 IPRATROPIUM (ATROVENT) MDI 14.7 GM 597008717 NDC 637 RC Facility Outpatient 1 UN 913 913 666.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 419.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 359.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 419.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 377.71 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 803.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 730.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 419.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 366.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 730.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 693.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 419.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 419.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 359 803 DIPHENOX/ATROPINE (LOMOTIL) TAB 2.5MG 59762106101 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 DOXAZOSIN (CARDURA) TABLET 8MG 59762238006 NDC 637 RC Facility Outpatient 8 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROCODON/PE/CPM (CYTUSS HC) SYRUP 5ML 60258070416 NDC 637 RC Facility Outpatient 5 ML 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 POTASSIUM CL(KLOR-CON) PKT 20MEQ 603155416 NDC 637 RC Facility Outpatient 20 UN 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 HYDROCOD/PSEUDOEPHED/CPM 5ML 603160958 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LIDOCAINE (LIDODERM) 5% PATCH 603188016 NDC 637 RC Facility Outpatient 1 UN 45 45 32.85 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.85 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 39 FIORINAL c COD (COD/APAP/BUTAL/CAF) CAP 603255321 NDC 637 RC Facility Outpatient 1 UN 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 PhenoBARBITAL TABLET 60MG 603516721 NDC 637 RC Facility Outpatient 64.8 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 PHENYTOIN (DILanTIN) 5ML UD 125MG 60432013108 NDC 637 RC Facility Outpatient 125 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (CARDIZEM CD) TABLET 120MG 60505001406 NDC 637 RC Facility Outpatient 120 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GABAPENTIN (NEURONTIN) CAPSULE 100MG 60505011200 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 glipiZIDE (GLUCOTROL) TABLET 10MG 60505014200 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CALCITONIN (MIACALCIN) NASAL 200 UNIT 60505082306 NDC 637 RC Facility Outpatient 1 UN 343 343 250.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 301.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 137.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 157.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 135 301 AMLODIPINE/BENZAPRIL(LOTREL) 5-10MG TAB 60505347803 NDC 637 RC Facility Outpatient 1 EA 13 13 9.49 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.12 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.89 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.44 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.98 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 11 FENTAnyl (DURAGESIC) PATCH 25MCG/HR 60505700600 NDC 637 RC Facility Outpatient 25 EA 75 75 54.75 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.75 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.5 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 FENTAnyl (DURAGESIC) PATCH 50MCG/HR 60505700702 NDC 637 RC Facility Outpatient 50 EA 142 142 103.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 124 FENTAnyl (DURAGESIC) PATCH 100MCG/HR 60505700902 NDC 637 RC Facility Outpatient 100 EA 276 276 201.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.18 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 242.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.92 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 220.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 108 242 DOCUSATE (COLACE) CAPSULE 100MG 60687012901 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SIMVASTATIN (ZOCOR) TABLET 40MG 60687021011 NDC 637 RC Facility Outpatient 40 ME 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 DOnepeZIL (ARICEPT) TAB 10 MG 60687030311 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METoproLOL SUCC (TOPROL XL) TABLET 50MG 60687040201 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (CARDIZEM) TABLET 30MG 60687056201 NDC 637 RC Facility Outpatient 30 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BRIMONIDINE (ALPHAGAN P)OPHTH 0.15% 5ML 61314014405 NDC 637 RC Facility Outpatient 1 UN 395 395 288.35 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 209.35 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 347.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 158.74 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 316 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 300.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 181.7 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155 347 TIMOLOL MALEATE XE 0.5% OPTH GEL 5ML 61314022505 NDC 637 RC Facility Outpatient 1 UN 302 302 220.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 160.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 124.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 265.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 121.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 241.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 229.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 138.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118 265 GENTAMICIN SULFATE OPHTH SOLN 5ML 61314063305 NDC 637 RC Facility Outpatient 1 UN 43 43 31.39 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.79 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 37.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.78 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 37 *NEOMYCIN/POLYMYXIN/HC (CORTISPORIN)OPTH 61314064175 NDC 637 RC Facility Outpatient 1 UN 419 419 305.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 222.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 173.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 368.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 335.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 168.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 335.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 318.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 192.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 165 368 glipiZIDE (GLUCOTROL XL) ER TAB 2.5MG 61442012101 NDC 637 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RAMIPRIL (ALTACE) CAPSULE 1.25 MG 61570011001 NDC 637 RC Facility Outpatient 1.2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MULTIVITAMIN INJECTION (MVI) 10ML 61703042281 NDC 258 RC Facility Outpatient 10 ML 40 40 29.2 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.2 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.08 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 35 RIFAMPIN CAPSULE 300MG 61748001801 NDC 637 RC Facility Outpatient 300 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DERMACERIN 61924017804 NDC 637 RC Facility Outpatient 1 UN 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 THEOPHYLLINE( THEODUR) E.R. 300MG 62332002531 NDC 637 RC Facility Outpatient 300 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METFORMIN (GLUCOPHAGE)TABLET 500MG 62584025911 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METOPROLOL TAR (LOPRESSOR)TAB 25MG 62584026501 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FOLIC ACID TABLET 1MG 62584089701 NDC 637 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 WARFARIN (COUMADIN) TABLET 2MG 62584098401 NDC 637 RC Facility Outpatient 2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 WARFARIN (COUMADIN) TABLET 5MG 62584099401 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARBIDOPA/LEVODOPA(SINEMET)TAB 10/100MG 62756051788 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FOLIC ACID TABLET 0.4MG 63323018410 NDC 637 RC Facility Outpatient 0.4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FOLic ACID 5MG/ML INJ 63323018411 NDC 250 RC Facility Outpatient 5 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 NACL 0.9% VIAL 10ML 63323018610 NDC 258 RC Facility Outpatient 10 ML 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 PROPOFOL (DIPRIVAN) 200MG/10ML VL 63323026916 NDC 250 RC Facility Outpatient 1 UN 57 57 41.61 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.21 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.16 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 43.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.22 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 50 CALCIUM GLUcoNATE 10% VIAL 10ML 1 GRAM 63323031110 NDC 250 RC Facility Outpatient 10 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 OCTREOTIDE (SANDOSTATIN) 1000MCG 5ML 63323037905 NDC 258 RC Facility Outpatient 1000 UN 1060 1060 773.8 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 561.8 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 438.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 932.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 848 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 425.99 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 848 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 805.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 487.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417 932 ROCURONIUM (ZEmuRON) 10MG/ML VIAL 5ML 63323042605 NDC 250 RC Facility Outpatient 50 ME 27 27 19.71 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.31 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.85 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.42 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 23 LIDOCAINE/EPINEPHRINE 1% MDV 20ML 63323048227 NDC 250 RC Facility Outpatient 20 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LIDOCAINE/EPINEPHRINE 2% MDV 20ML 63323048327 NDC 250 RC Facility Outpatient 20 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 LIDOCAINE (XYLOCAINE) 2% MDV 20ML 63323048627 NDC 250 RC Facility Outpatient 20 ML 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 ENOXAPARIN (LOVENOX) SYRINGE 0.3ML 30MG 63323056883 NDC 250 RC Facility Outpatient 30 ME 126 126 91.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 100.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 95.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49 110 CLOPIDOGREL (PLAVIX) 75MG TAB 63653117103 NDC 637 RC Facility Outpatient 75 ME 42 42 30.66 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.26 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.38 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.32 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 36 HYDROcoDONE/ACET(VICODIN) 5MG/500MG TAB 63739014110 NDC 637 RC Facility Outpatient 5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 PhenoBARBITAL TABLET 16.2MG 63739020010 NDC 637 RC Facility Outpatient 16.2 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 PhenoBARBITAL TABLET 30MG 63739020110 NDC 637 RC Facility Outpatient 30 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PhenoBARBITAL TABLET 32.4MG 63739020110 NDC 637 RC Facility Outpatient 32.4 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 SIMETHICONE (GAS-X) CHEWABLE TAB 80MG 63739022510 NDC 637 RC Facility Outpatient 80 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BACLOFEN (LIORESAL) TABLET 10MG 63739047910 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METOcloPRAMIDE HCL (REGLAN) TAB 10MG 63739048210 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 TAMSULOSIN (FLOMAX) CAPSULE 0.4MG 63739056710 NDC 637 RC Facility Outpatient 0.4 ME 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 GUAifenESIN ER (MUCINEX) TABLET 600MG 63824000834 NDC 637 RC Facility Outpatient 600 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GUAIFEN/PSEUDO(MUCINEX D)TAB 600/120 63824005736 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROMETHAZINE (PHENERGAN) INJ 50MG 641092925 NDC 250 RC Facility Outpatient 50 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 DILTIAZEM HCL (CARDIZEM) 5ML 25MG 641601310 NDC 250 RC Facility Outpatient 25 ME 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 DILTIAZEM HCL (CARDIZEM) INJ 125MG 641601510 NDC 250 RC Facility Outpatient 125 ME 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 SALINE FLUSH SYRINGE 10ML 64253011130 NDC 250 RC Facility Outpatient 10 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CEFUROXIME (CEFTIN) TABLET 250MG 64679092101 NDC 637 RC Facility Outpatient 250 ME 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 ENALAPRIL (VASOTEC) TAB 10MG 64679092502 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LANSOPRAZOLE (PREVACID) CAP 30MG 64764004613 NDC 637 RC Facility Outpatient 30 ME 24 24 17.52 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.46 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.72 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 21 LANSOPRAZOLE (PREVACID) SOLUTAB 30MG 64764054411 NDC 637 RC Facility Outpatient 30 ME 37 37 27.01 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.61 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.87 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.02 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 32 DIPYRIDAMOLE (PERSANTINE) TABLET 25MG 64980013301 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACIDOPHILUS/BULGARICUS (LACTINEX) PACKET 64980014612 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROcortISONE RECTAK CREAM 2.5% 30GM 64980030130 NDC 637 RC Facility Outpatient 1 UN 129 129 94.17 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68.37 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.37 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 113.52 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59.34 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 113 ACYCLOVIR (ZOVIRAX) OINT 15GM 65162083594 NDC 637 RC Facility Outpatient 1 UN 1052 1052 767.96 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 414.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 557.56 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 435.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 925.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 841.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 422.78 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 841.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 799.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 483.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 414 925 ESCITALOPRAM (LEXAPRO) TAB 10MG 65862037401 NDC 637 RC Facility Outpatient 10 ME 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 RAMIPRIL (ALTACE) CAPSULE 2.5 MG 65862047501 NDC 637 RC Facility Outpatient 2.5 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 RAMIPRIL (ALTACE) CAPSULE 5 MG 65862047601 NDC 637 RC Facility Outpatient 5 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 VENLAFAXINE (EFFEXOR) ER CAP 37.5MG 65862052730 NDC 637 RC Facility Outpatient 37.5 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 VENLAFAXINE (EFFEXOR) TABLET 75MG 65862052830 NDC 637 RC Facility Outpatient 75 ME 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 ALPRAZolam (XANAX) TABLET 1 MG 65862067801 NDC 637 RC Facility Outpatient 1 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 ASPIRIN TABLET 325 MG 66553000101 NDC 637 RC Facility Outpatient 325 ME 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 CALCIUM CARBONATE (OSCAL) TAB 500 MG 66553000401 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CALCIUM CARB (TUMS) CHEW TABLET 500 MG 66553000401 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SODIUM BICARBONATE TABLET 650MG 66553000801 NDC 637 RC Facility Outpatient 650 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 "NystaTIN SUSP 100,000 UNITS/ML 5ML" 66689003701 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LACTULOSE 10GRAM/15ML SOLN 30ML 66689003801 NDC 637 RC Facility Outpatient 30 ML 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 BELLADONNA ALK/PB (DONNATAL) ELIX 5ML 66689006310 NDC 637 RC Facility Outpatient 5 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACTIVATED CHARCOAL / SORBITOL SUSP 50GM 66689020308 NDC 637 RC Facility Outpatient 50 GM 122 122 89.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48.07 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 64.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.47 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 97.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 48 107 SUCRALFATE (CARAFATE)SUSP 1GM/10ML 66689079050 NDC 637 RC Facility Outpatient 1 GM 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 SCOPOLAMINE(TRANSDERM SCOP)PATCH 1MG 66758020854 NDC 637 RC Facility Outpatient 1 UN 76 76 55.48 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.28 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 66 CHLORHEX GL/ISOPROP (HIBICLENS) 118ML 67618020004 NDC 637 RC Facility Outpatient 118 ML 22 22 16.06 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.67 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.66 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.1 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.36 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.84 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.12 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 19 CHLORHEX GL/ISOPROP (HIBICLENS) 3840ML 67618020008 NDC 637 RC Facility Outpatient 3840 ML 186 186 135.78 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73.28 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98.58 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.95 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.75 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 148.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 85.56 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73 163 SILVER SULF (SILVADENE) CREAM 1% 25GM 67877012425 NDC 637 RC Facility Outpatient 1 UN 26 26 18.98 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.78 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.88 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.96 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 22 GABAPENTIN (NEURONTIN) CAPSULE 300MG 67877022305 NDC 637 RC Facility Outpatient 300 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 QUETIAPINE (SEROQUEL) TABLET 25MG 67877024201 NDC 637 RC Facility Outpatient 25 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 QUETIAPINE (SEROQUEL) TABLET 100MG 67877025010 NDC 637 RC Facility Outpatient 100 ME 33 33 24.09 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.49 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.65 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.26 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.18 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 29 BENZONATATE (TESSALON PERLE) CAP 100MG 67877057301 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PAROXETINE (PAXIL) TABLET 20MG 68084004501 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ATORVASTATIN (LIPITOR) TABLET 10 MG 68084009701 NDC 637 RC Facility Outpatient 10 ME 14 14 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 ATORVASTATIN (LIPITOR) TABLET 20 MG 68084009801 NDC 637 RC Facility Outpatient 20 ME 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 ATORVASTATIN (LIPITOR) TABLET 40 MG 68084009901 NDC 637 RC Facility Outpatient 40 ME 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 PROMETHAZINE (PHENERGAN) TABLET 25MG 68084015501 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MINOXIDIL 2.5MG TAB 68084020401 NDC 637 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SULFAMETHOXAZOLE/TMP DS TAB 800/160MG 68084023001 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LORATADINE (CLARITIN) TABLET 10MG 68084024801 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RISPERIDONE (RISPERDAL) TABLET 0.25MG 68084027001 NDC 637 RC Facility Outpatient 0.2 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 RISPERIDONE (RISPERDAL) TABLET 0.5MG 68084027101 NDC 637 RC Facility Outpatient 0.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARBI/LEVO ER(SINEMET) TABLET 50/200MG 68084028201 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 LOSARTAN (COZAAR) TABLET 50MG 68084034701 NDC 637 RC Facility Outpatient 50 ME 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 LOSARTAN (COZAAR) TABLET 100MG 68084034801 NDC 637 RC Facility Outpatient 100 ME 17 17 12.41 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.7 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.01 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 DIVALPROEX SODIUM (DEPAKOTE) ER 500MG 68084041501 NDC 637 RC Facility Outpatient 500 ME 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 MECLIZINE (ANTIVERT) TABLET 12.5MG 68084049001 NDC 637 RC Facility Outpatient 12.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MECLIZINE (ANTIVERT) TABLET 25MG 68084049101 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SIMVASTATIN (ZOCOR) TABLET 10 MG 68084051101 NDC 637 RC Facility Outpatient 10 ME 15 15 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 IBUPROFEN (MOTRIN) TABLET 800MG 68084077201 NDC 637 RC Facility Outpatient 800 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MYLANTA DS 30ML UD 68094057361 NDC 637 RC Facility Outpatient 30 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CEPHALEXIN (KEFLEX) CAPSULE 250MG 68180012101 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SertrALINE (ZOLOFT) TAB 25MG 68180035109 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 SertrALINE (ZOLOFT) TAB 50MG 68180035209 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LISINOPRIL (ZESTRIL) TABLET 5MG 68180051301 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LISINOPRIL/HCT(ZESTORETIC) TAB 10-12.5MG 68180051801 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LEVOTHYROXINE (SYNTHROID) TAB 88MCG 68180096809 NDC 637 RC Facility Outpatient 88 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LISINOPRIL (ZESTRIL) TABLET 20 MG 68180098103 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARVEDILOL (COREG) TABLET 6.25MG 68382009305 NDC 637 RC Facility Outpatient 6.2 ME 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 NITROglyCERIN (NITRO-BID) PATCH 0.4MG 68382031001 NDC 637 RC Facility Outpatient 1 UN 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 MESALAMINE (ASACOL)TABLET 400 MG 68382048428 NDC 637 RC Facility Outpatient 400 ME 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 DILTIAZEM HCL (CARDIZEM) ER CAP 120MG 68382059516 NDC 637 RC Facility Outpatient 120 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL(CARDIZEM CD) ER CAP 180MG 68382059616 NDC 637 RC Facility Outpatient 180 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DILTIAZEM HCL (CARDIZEM) CD CAP 300MG 68382059816 NDC 637 RC Facility Outpatient 300 ME 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 SPIRONOLACTONE (ALDACTONE) TAB 25 MG 68382066005 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NAPROXEN (NAPROSYN) TABLET 500MG 68462019001 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VERAPAMIL (CALAN) ER TABLET 240MG 68462026001 NDC 637 RC Facility Outpatient 240 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VERAPAMIL ER (CALAN) TABLET 180 MG 68462029301 NDC 637 RC Facility Outpatient 180 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MAGNESIUM CHLORIDE 64MG TAB 68585000575 NDC 637 RC Facility Outpatient 64 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NIFEdipine(PROCARDIA XL) ER TABLET 30MG 68682010810 NDC 637 RC Facility Outpatient 30 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GEMFIBROZIL (LOPID) TABLET 600MG 69097082103 NDC 637 RC Facility Outpatient 600 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BUMETANIDE (BUMEX) TABLET 0.5MG 69238148901 NDC 637 RC Facility Outpatient 0.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FuroSEMIDE (LASIX) TABLET 20MG 69315011610 NDC 637 RC Facility Outpatient 20 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LORAZEPAM (ATIVAN) TABLET 1 MG 69315090501 NDC 637 RC Facility Outpatient 1 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 PHENYLEPHRINE NASAL SPRAY 0.5% 15ML 69536015015 NDC 637 RC Facility Outpatient 1 UN 20 20 14.6 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.88 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.6 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.6 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.04 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.2 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 17 HYDROGEN PEROXIDE 3% 237ML 70000002201 NDC 250 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 GUAIFENESIN-DM LIQUID 10 ML 70000031902 NDC 637 RC Facility Outpatient 10 ML 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 LOPERAMIDE (IMODIUM) LIQ 7.5ML 1MG 70000041701 NDC 637 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 methylPREDNISolone (DEPO-MEDROL) 40MG 703003101 NDC 636 RC Facility Outpatient 40 ME 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 AMITRIPTYLINE (ELAVIL) TABLET 25 MG 70756020211 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMITRIPTYLINE (ELAVIL) TABLET 50 MG 70756020311 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROCHLORPERAZINE (COMPAZINE) SUPP 25MG 713013512 NDC 637 RC Facility Outpatient 25 ME 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 HEMMORRHOID SUPP 713050312 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROcortISONE ACE(ANUCORT HC)SUPP 25MG 713050312 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PROMETHAZINE (PHENERGAN) SUPP 25MG 713052612 NDC 637 RC Facility Outpatient 25 ME 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 ACETAMIN/CODEINE (TYLENOL #3)TAB 30 MG 71930005512 NDC 637 RC Facility Outpatient 1 EA 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 DIAPER RELIEF OINT 74300049516 NDC 637 RC Facility Outpatient 1 UN 16 16 11.68 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.3 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.48 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.08 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.43 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.36 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6 14 ACETAMIN/ASA/CAFF (GOODYS) HEADACHE TAB 74684000104 NDC 637 RC Facility Outpatient 1 UN 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 MORphine SULFATE PCA 1MG/ML INJ 30ML 76329191101 NDC 636 RC Facility Outpatient 30 ME 67 67 48.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 58.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.93 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 53.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 58 DEXTROSE 50% INJECTION 50 ML 76329330101 NDC 250 RC Facility Outpatient 25 GM 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 BENZTROPINE (COGENTIN) TABLET 1 MG 76385010401 NDC 637 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CHLORASEPTIC SPRAY 177 ML 78112001103 NDC 637 RC Facility Outpatient 1 EA 11 11 8.03 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.33 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.83 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.68 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.42 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.06 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 9 ISOSORBIDE DINITRATE (ISORDIL) TAB 10MG 781155601 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMANTADINE (SYMMETREL) CAP 100 MG 781204801 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 AMPICILLIN CAPSULE 250 MG 781214401 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 cefTRIAXone (ROCEPHIN) VIAL 1GM 781320885 NDC 250 RC Facility Outpatient 1 GM 21 21 15.33 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.27 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.13 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.69 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.48 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.44 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.66 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 18 ENOXAPARIN (LOVENOX) SYRINGE 0.4ML 40MG 781322464 NDC 250 RC Facility Outpatient 40 ME 167 167 121.91 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88.51 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 69.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146.96 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 67.11 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 133.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 126.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 76.82 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 65 146 LEVOFLOXACIN (LEVAQUIN) IVPB 50ML 250MG 781334152 NDC 258 RC Facility Outpatient 250 ME 115 115 83.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 101.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 46.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 92 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 87.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 101 ENOXAPARIN (LOVENOX) SYRINGE 0.6ML 60MG 781335666 NDC 250 RC Facility Outpatient 60 ME 284 284 207.32 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111.9 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 150.52 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 249.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 114.13 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 227.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 130.64 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 111 249 ENOXAPARIN (LOVENOX) SYRINGE 1ML 100MG 781350069 NDC 250 RC Facility Outpatient 100 ME 474 474 346.02 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.76 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 251.22 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 417.12 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 379.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 190.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 379.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 360.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.04 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186 417 PIOGLITAZONE (ACTOS) TABLET 15 MG 781542031 NDC 637 RC Facility Outpatient 15 ME 30 30 21.9 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.9 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.41 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26.4 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.8 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 26 EZETIMIBE (ZETIA) TAB 10MG 781569031 NDC 637 RC Facility Outpatient 10 ME 19 19 13.87 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.49 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.07 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.86 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.64 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.74 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 16 POTASSIUM CHLORIDE(KLOR-CON) TAB 20MEQ 781572010 NDC 637 RC Facility Outpatient 20 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BABY OIL 81370003339 NDC 637 RC Facility Outpatient 1 UN 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 BISACODYL (DULCOLAX) SUPPOSITORY 10 MG 81421002105 NDC 637 RC Facility Outpatient 10 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 VASOLINE LIP CARE 83078000314 NDC 637 RC Facility Outpatient 1 UN 12 12 8.76 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.73 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.36 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.96 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.56 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.82 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4 10 WARFARIN (COUMADIN) TABLET 1MG 832121101 NDC 637 RC Facility Outpatient 1 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 WARFARIN (COUMADIN) TABLET 2.5MG 832121301 NDC 637 RC Facility Outpatient 2.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 WARFARIN (COUMADIN) TABLET 3MG 832121401 NDC 637 RC Facility Outpatient 3 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 WARFARIN (COUMADIN) TABLET 4MG 832121501 NDC 637 RC Facility Outpatient 4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 IV BAG 250ML EMPTY 85412003196 NDC 258 RC Facility Outpatient 1 UN 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 IV BAG 150ML EMPTY 85412003462 NDC 258 RC Facility Outpatient 1 UN 23 23 16.79 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.19 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.24 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.58 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 20 ISOPROPYL ALCOHOL 70% SOLN 473 ML 869081043 NDC 637 RC Facility Outpatient 1 UN 15 15 10.95 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.91 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.95 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.21 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.2 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.9 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 13 PHENAZOPYRIDINE (PYRIDIUM) TABLET 100MG 87651076000 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ASCORBIC ACID (VITAMIN C) TABLET 500 MG 904052361 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MULTIVITAMIN TABLET 904053061 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 BISMUTH SUBSALICYLATE (PEPTO BIS) 30ML 904131309 NDC 637 RC Facility Outpatient 30 ML 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 diphenhydrAMINE (BENADRYL) CAPSULE 50MG 904205661 NDC 637 RC Facility Outpatient 50 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CALCIUM POLYCARBOPHIL (FIBERCON) TABLET 904250091 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 OXYbutyNIN (DITROPAN) TABLET 5MG 904282161 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 carBAMazepine (TEGRETOL)TABLET 100MG 904385461 NDC 637 RC Facility Outpatient 100 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 diphenhydrAMINE (BENADRYL) CAPSULE 25MG 904530661 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 IRON POLYSACCHARIDE COMPLEX 150MG 904539561 NDC 637 RC Facility Outpatient 150 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 MV SENIOR CAP 904548652 NDC 637 RC Facility Outpatient 1 EA 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN (NITRO-BID) PATCH 5MG 904549546 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 NITROglyCERIN (NITRO-BID) PATCH 10MG 904549646 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DOXAZOSIN (CARDURA) TABLET 4MG 904552461 NDC 637 RC Facility Outpatient 4 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 PAROXETINE (PAXIL) TABLET 10MG 904567661 NDC 637 RC Facility Outpatient 10 ME 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 FluoXETINE (PROZAC) CAPSULE 10MG 904578461 NDC 637 RC Facility Outpatient 10 ME 14 14 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 IBUPROFEN (MOTRIN) TABLET 400MG 904585361 NDC 637 RC Facility Outpatient 400 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 IBUPROFEN (MOTRIN) TABLET 600MG 904585461 NDC 637 RC Facility Outpatient 600 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ZOLPIDEM (AMBIEN) TAB 5 MG 904608261 NDC 637 RC Facility Outpatient 5 ME 18 18 13.14 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.09 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.54 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.45 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.84 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.23 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.28 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7 15 CITALOPRAM HYDROBROMIDE(CeleXA) TAB 20MG 904608561 NDC 637 RC Facility Outpatient 20 ME 14 14 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 CARBAMAZEPINE (TEGRETOL) TABLET 200MG 904617261 NDC 637 RC Facility Outpatient 200 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CARBIDOPA/LEVODOPA(SINEMET)TAB 25/250MG 904623861 NDC 637 RC Facility Outpatient 1 EA 9 9 6.57 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.55 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.77 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.72 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.92 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.62 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 CEPACOL LOZENGE (BENZOCAINE/MENTHOL) 904625549 NDC 637 RC Facility Outpatient 1 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ZIPRASIDONE (GEODON) CAPSULE 20MG 904626908 NDC 637 RC Facility Outpatient 20 ME 44 44 32.12 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.34 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.32 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.2 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38.72 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.68 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 33.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20.24 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 38 CARVEDILOL (COREG) TABLET 12.5MG 904630261 NDC 637 RC Facility Outpatient 12.5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METoproLOL SUCC (TOPROL XL) TABLET 25MG 904632261 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 METoproLOL SUCC (TOPROL XL) TAB 100MG 904632461 NDC 637 RC Facility Outpatient 100 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 LEVOFLOXACIN (LEVAQUIN) TABLET 250MG 904635161 NDC 637 RC Facility Outpatient 250 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 amLODIPine (NORVASC) TAB 2.5 MG 904636961 NDC 637 RC Facility Outpatient 2.5 ME 10 10 7.3 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.94 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.3 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.14 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.8 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.02 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.6 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 8 BISACODYL (DULCOLAX) TABLET 5MG 904640761 NDC 637 RC Facility Outpatient 5 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 hydrALAZINE (APRESOLINE) TAB 25 MG 904644161 NDC 637 RC Facility Outpatient 25 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ACETAMINOPHEN (TYLENOL) TABLET 500 MG 904673061 NDC 637 RC Facility Outpatient 500 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 DROnabiNOL (MARINOL) TABLET 5MG 904674604 NDC 637 RC Facility Outpatient 5 ME 56 56 40.88 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.06 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.68 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.17 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 49.28 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.51 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.76 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22 49 MAGNESIUM CITRATE 10 OZ 904678744 NDC 637 RC Facility Outpatient 10 UN 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 ASPIRIN CHEWABLE TABLET 81 MG 904679480 NDC 637 RC Facility Outpatient 81 ME 2 2 1.46 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.06 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.83 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.76 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.8 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 0.92 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1 1 FERROUS SULFATE TABLET 325 MG 904759161 NDC 637 RC Facility Outpatient 325 ME 8 8 5.84 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.15 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 4.24 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.31 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.04 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.22 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3.68 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 3 7 HYDROcortISONE CREAM 1% 28.35 904762331 NDC 637 RC Facility Outpatient 1 UN 14 14 10.22 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.52 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.42 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.79 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.32 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5.63 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.44 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 5 12 D5/NS 0.45% c KCL 20MEQ IV 1000ML 990790209 NDC 258 RC Facility Outpatient 20 UN 103 103 75.19 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 54.59 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 42.61 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 90.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.39 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47.38 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 90 NACL 0.9% IRRIGATION 500ML 990798361 NDC 258 RC Facility Outpatient 500 ML 28 28 20.44 73 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.03 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.84 53 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.58 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.64 88 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.25 39.4 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.88 46 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 24 ESMOLOL (BREVIBLOC) 10ML 100MG 10019007587 NDC 250 RC Facility Inpatient 10 ME 98 98 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 98 DESFLURANE (SUPRANE) (15MIN INTERVALS) 10019064134 NDC 250 RC Facility Inpatient 1 UN 88 88 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 66 88 EYE WASH 10119000252 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 EYE IRRIGATING SOLUTION 118ML 10119000252 NDC 637 RC Facility Inpatient 1 UN 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 CHLORPHENIRAMINE TABLET 4MG 10135013324 NDC 637 RC Facility Inpatient 4 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BENZOCAINE/TETRACAINE/BUTAMBEN(CETACAINE 10223020101 NDC 250 RC Facility Inpatient 1 UN 40.18 40.18 40.18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 40.18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40.18 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 40.18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 40.18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40.18 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 32.14 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40.18 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 32.14 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.54 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40.18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40.18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 40 ANTIPYRINE/BCAINE (AURALGAN) OTIC 10 ML 10310021601 NDC 637 RC Facility Inpatient 1 UN 59 59 59 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 59 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 44 59 OXYCODONE/APAP TABLET 5/325 10702018501 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 ANALGESIC RUB 10742000102 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PROPRANOLOL (INDERAL) TABLET 10MG 115165901 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 OXYMETAZOLINE (AFRIN) NASAL SPRAY 15ML 11523170201 NDC 637 RC Facility Inpatient 1 UN 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 BAZA TOPICAL CREAM 11701004514 NDC 637 RC Facility Inpatient 1 UN 26 26 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 26 MICONAZOLE (MONISTAT) VAG CREAM 11701004514 NDC 637 RC Facility Inpatient 1 UN 41 41 41 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 41 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 41 MAGNESIUM HYDROXIDE (MOM) SUSP 30ML 121043130 NDC 637 RC Facility Inpatient 30 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 diphenhydrAMINE(BENADRYL)ELIX 5ML12.5MG 121048905 NDC 637 RC Facility Inpatient 12.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMIN/COD ELIX (TYLENOL) 5ML 12/120MG 121050416 NDC 637 RC Facility Inpatient 5 ML 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 FERROUS SULFATE ORAL SOLN 330MG/7.5ML 121053005 NDC 637 RC Facility Inpatient 325 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DOCUSATE (COLACE) SYRUP 100MG/10ML 121054410 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LACTUlose SYRUP 30ML 121057708 NDC 637 RC Facility Inpatient 10 GM 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GUAifenESIN (ROBITUSSIN) LIQUID 10ML 121063805 NDC 637 RC Facility Inpatient 10 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMINOPHEN (TYLENOL) SOLN 325 MG 121065711 NDC 637 RC Facility Inpatient 325 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GUAIFEN/COD (ROBITUSSIN AC) SYRUP 5ML 121077504 NDC 637 RC Facility Inpatient 5 ML 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 SODIUM CIT/CITRIC ACID SOLN 30ML 121119000 NDC 637 RC Facility Inpatient 30 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 METOcloPRAMIDE(REGLAN)ORAL SOLN 5ML 5MG 121157610 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GUAifenESIN (ROBITUSSIN) LIQUID 5ML 121174405 NDC 637 RC Facility Inpatient 5 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MAG / AL HYDROXIDE/SIM (MYLANTA) 10ML 121176030 NDC 637 RC Facility Inpatient 10 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HYDROcoDONE/APAP 7.5-500MG ELIXER 121465515 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 diphenhydrAMINE HCL/ZINC ACET CREAM 12547017162 NDC 637 RC Facility Inpatient 1 UN 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 SODIUM PHOSPHATE(FLEET PHOSPHO SODA)45ML 132010701 NDC 637 RC Facility Inpatient 45 ML 15 15 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 15 MINERAL OIL (FLEET) ENEMA 133ML 132030140 NDC 637 RC Facility Inpatient 1 UN 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 SODIUM PHOS MB/SODIUM PHOS DB 132080199 NDC 637 RC Facility Inpatient 1 UN 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 PhenoBARBITAL ELIXER UD 5ML 20MG 13517010716 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BELLADONNA/PHENOBARBITAL (DONNATAL) TAB 143114010 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MEthOcarBAMOL (ROBAXIN) TABLET 500MG 143129001 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MEthOcarBAMOL (ROBAXIN) TABLET 750MG 143129201 NDC 637 RC Facility Inpatient 750 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMIN/BUTALB/CAFFEINE 325/50/40MG TAB 143178701 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GLYCOPYRROLATE (ROBINUL) INJ 2ML 0.4MG 143968101 NDC 250 RC Facility Inpatient 0.4 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 LEVOFLOXACIN(LEVAQUIN) IVPB 150ML 750MG 143972001 NDC 258 RC Facility Inpatient 750 ME 259 259 259 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 259 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 259 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 259 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 259 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 259 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 259 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 207.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 196.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 259 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 259 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 196 259 ENALAPRILAT (VASOTEC) INJ 1.25 MG/ML 143978710 NDC 250 RC Facility Inpatient 1.2 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 CEPHALEXIN (KEFLEX) CAPSULE 500MG 143989701 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMOXICILLIN (AMOXIL) CAPSULE 500 MG 143993901 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ALENDRONATE SODIUM (FOSAMAX) 70MG TAB 16252060144 NDC 637 RC Facility Inpatient 70 ME 106 106 106 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 106 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 106 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 106 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 106 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 106 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 106 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 84.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 106 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 80 106 HYDROchloroTHIAZIDE TABLET 25MG 16729018301 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BETAMETHASONE VALERATE OINTMENT 0.1% 168003346 NDC 258 RC Facility Inpatient 1 UN 94 94 94 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 94 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 94 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 94 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 94 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 94 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 94 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 75.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 71.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 94 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 94 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 71 94 VASOLINE TOPICAL JEL 168005321 NDC 637 RC Facility Inpatient 1 UN 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 ZINC OXIDE 20% OINT 28.35 168006231 NDC 637 RC Facility Inpatient 1 UN 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 FLUOCINOLONE (DERMASMOOTH) SCALP OIL 120 168006415 NDC 637 RC Facility Inpatient 1 UN 170 170 170 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 170 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 129 170 EryTHROMYCIN (BASE) 1GM 168007011 NDC 637 RC Facility Inpatient 5 ME 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 CLOTRIMAZOLE/BETAMETH(LOTRISONE)CR 15GM 168025815 NDC 637 RC Facility Inpatient 1 UN 155 155 155 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 155 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 155 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 155 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 124 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 117.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 117 155 CLOTRIMAZOLE/BETAMETH(LOTRISONE)CRM 45GM 168025846 NDC 637 RC Facility Inpatient 1 UN 336 336 336 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 336 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 336 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 336 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 336 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 336 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 336 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 268.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 255.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 336 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 336 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 255 336 AMCINONIDE CREAM (CYCLOCORT) 60GM 168027860 NDC 637 RC Facility Inpatient 1 UN 205 205 205 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 205 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 205 NITROglyCERIN OINT 15GM 168032630 NDC 637 RC Facility Inpatient 1 UN 47 47 47 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 47 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 47 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 47 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 47 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 47 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 47 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 37.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 35.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 47 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 47 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 35 47 FLUORESCEIN (FLUOR-I-STRIP) OPHTH STRIP 17238090030 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 FLUCONAZOLE (DIFLUCAN) TABLET 100MG 172541146 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 FLUCONAZOLE (DIFLUCAN) TABLET 150MG 172541211 NDC 637 RC Facility Inpatient 150 ME 73 73 73 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 73 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 73 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 73 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 73 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 73 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 73 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 58.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 73 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 73 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 55 73 FAMOTIDINE (PEPCID) TABLET 20MG 172572870 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DIGOXIN (LANOXICAP) CAPSULE 0.1 MG 173027255 NDC 637 RC Facility Inpatient 0.1 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ALBUTErol (PROVENTIL) MDI INHALER 17GM 173068220 NDC 637 RC Facility Inpatient 1 UN 213 213 213 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 213 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 213 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 213 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 213 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 213 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 213 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 170.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 161.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 213 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 213 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 161 213 ADVAIR 100-50 INHALER 14 DOSE 173069604 NDC 637 RC Facility Inpatient 1 UN 466 466 466 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 466 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 466 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 466 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 466 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 466 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 372.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 466 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 466 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 372.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 354.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 466 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 466 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 354 466 ADVAIR DISKUS 250/50 14 DISK 173069604 NDC 258 RC Facility Inpatient 1 UN 465 465 465 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 465 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 465 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 465 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 465 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 465 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 372 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 465 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 372 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 353.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 465 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 465 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 353 465 ADVAIR 500-50 INHALER 14 DOSE 173069704 NDC 637 RC Facility Inpatient 1 UN 837 837 837 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 837 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 837 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 837 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 837 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 837 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 669.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 837 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 669.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 636.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 837 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 837 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 636 837 DUTASTERIDE (AVODART) CAP 0.5MG 173071215 NDC 637 RC Facility Inpatient 0.5 ME 23 23 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 23 ROSIGLITAZONE (AVANDIA)TAB 2 MG 173086118 NDC 637 RC Facility Inpatient 2 ME 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 ROSIGLITAZONE (AVANDIA) TAB 4 MG 173086313 NDC 637 RC Facility Inpatient 4 ME 25 25 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 25 VALACYCLOVIR (VALTREX) TABLET 500 MG 173093308 NDC 637 RC Facility Inpatient 500 ME 38 38 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 38 EryTHROMYCIN OPHTH OINT 5% 3.5GM 17478007035 NDC 637 RC Facility Inpatient 1 UN 98 98 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 98 LEVALBUTEROL (XopENEX) INH 1.25MG 3ML 17478017424 NDC 637 RC Facility Inpatient 1.2 ME 23 23 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 23 GENTAMICIN SULFATE 0.3% OPHTH DROP 5ML 17478028310 NDC 637 RC Facility Inpatient 1 UN 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 GENTAMICIN SULFATE OPHTH OINT 3.5GM 17478028435 NDC 637 RC Facility Inpatient 1 UN 88 88 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 66 88 TIMOLOL MALEATE OPHTH SOL 0.5% 17478028810 NDC 637 RC Facility Inpatient 1 UN 88 88 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 88 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 70.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 66.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 88 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 66 88 LATANOPROST (XALANTAN) OPHTH SOL 2.5ML 17478062512 NDC 637 RC Facility Inpatient 1 UN 68 68 68 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 68 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 68 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 68 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 68 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 68 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 68 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 54.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 51.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 68 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 68 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 51 68 LIDOCAINE (XYLOCAINE) 2% JELLY 5ML 17478071110 NDC 637 RC Facility Inpatient 5 ML 41 41 41 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 41 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 32.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 41 OFLOXACIN 0.3%(FLOXIN) OPHTH SOL 5ML 17478071310 NDC 637 RC Facility Inpatient 1 UN 248 248 248 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 248 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 248 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 248 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 248 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 248 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 198.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 248 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 248 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 198.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 248 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 248 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 188 248 CIPROFLOXACIN (CIPRO) OPHTH SOLN 5ML 17478071410 NDC 637 RC Facility Inpatient 1 UN 245 245 245 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 245 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 245 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 245 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 245 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 245 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 245 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 245 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 196 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 186.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 245 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 245 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 186 245 TIZANIDINE (ZANAFLEX) TAB 4MG 185440051 NDC 637 RC Facility Inpatient 4 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DILTIAZEM HCL (TIAZAC) TABLET 360MG 187261630 NDC 637 RC Facility Inpatient 360 ME 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 NITROPRUSSIDE 50MG/2ML INJ 187430202 NDC 258 RC Facility Inpatient 50 ME 170 170 170 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 170 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 136 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 129.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 170 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 129 170 HYOSCYAMINE SULF(LEVSIN) SL TAB 0.125MG 225029515 NDC 637 RC Facility Inpatient 0.1 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ALPRAZolam (XANAX) TABLET 0.25MG 228202710 NDC 637 RC Facility Inpatient 0.2 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 TEMAZEPAM (RESTORIL) CAP 15MG 228207610 NDC 637 RC Facility Inpatient 15 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 CLONIDINE (CATAPRES) TABLET 0.3MG 228212910 NDC 637 RC Facility Inpatient 0.3 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NIFEdipine (PROCARDIA) CAPSULE 10MG 228249710 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ISOSORBIDE MONONITRATE (MONOKET) TB 20MG 228262011 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 clonazePAM (KLONIPIN) TABLET 0.5MG 228300311 NDC 637 RC Facility Inpatient 0.5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 ARTIFICIAL TEARS (LACRILUBE) OINT 3.5GM 23031204 NDC 637 RC Facility Inpatient 1 UN 45 45 45 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 45 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 45 METFORMIN (GLUCOPHAGE) TABLET 850MG 23155010301 NDC 637 RC Facility Inpatient 850 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 hydrALAZINE (APRESOLINE) TAB 10 MG 23155083201 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BIMATOPROST (LUMIGAN) OPHTH SOLN 2.5ML 23320503 NDC 637 RC Facility Inpatient 1 UN 482 482 482 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 482 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 482 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 482 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 482 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 482 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 385.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 482 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 482 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 385.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 366.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 482 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 482 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 366 482 KETOROLAC (ACULAR LS) OPHTH SOLN 5ML 23927705 NDC 637 RC Facility Inpatient 1 UN 511 511 511 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 511 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 511 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 511 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 511 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 511 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 408.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 511 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 408.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 388.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 511 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 511 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 388 511 BRIMONIDINE (ALPHAGAN P) OPHTH 0.1% 5ML 23932105 NDC 637 RC Facility Inpatient 1 UN 372 372 372 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 372 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 372 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 372 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 372 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 372 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 297.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 372 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 297.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 282.72 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 372 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 372 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 282 372 LOTEPREDNOL(LOTEMAX) OPHTH 0.5% 5ML 24208029905 NDC 637 RC Facility Inpatient 1 UN 189 189 189 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 189 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 189 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 189 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 189 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 189 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 189 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 151.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 143.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 189 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 189 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 143 189 NEO/POLY/HC (CORTISPORIN)OTIC DROP 10ML 24208063562 NDC 637 RC Facility Inpatient 1 UN 159 159 159 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 159 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 159 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 159 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 159 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 159 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 159 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 127.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 120.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 159 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 159 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 120 159 SULFACETAMIDE SODIUM 10% OPHTH DROP 15ML 24208067004 NDC 637 RC Facility Inpatient 1 UN 83 83 83 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 83 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 83 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 83 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 83 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 83 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 83 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 66.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 63.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 83 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 63 83 CYCLOPENTOLATE HCL OPHTH DROP 15ML 24208073506 NDC 637 RC Facility Inpatient 1 UN 32 32 32 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 32 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 32 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 32 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 32 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 32 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 32 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 25.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 32 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 32 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 32 NEO/POLY/DEX (MAXITROL)OPHTH OINT 3.5GM 24208079535 NDC 637 RC Facility Inpatient 1 UN 98 98 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 98 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 78.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 98 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 98 POTASSIUM CHLORIDE (KLOR-CON) TAB 10MEQ 245004101 NDC 637 RC Facility Inpatient 10 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMIODARONE (PACERONE) TABLET 200 MG 245014701 NDC 637 RC Facility Inpatient 200 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 POTASSIUM CHLORIDE (KLOR-CON) TAB 10MEQ 245531701 NDC 637 RC Facility Inpatient 10 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 IRBESARTAN (AVAPRO) TABLET 150 MG 24585130 NDC 637 RC Facility Inpatient 150 ME 15 15 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 15 SPIRONOLACTONE (ALDACTONE) TAB 100 MG 25103131 NDC 637 RC Facility Inpatient 100 ME 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 CELECOXIB (CeleBREX) CAPSULE 100MG 25152034 NDC 637 RC Facility Inpatient 100 ME 16 16 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 16 CELECOXIB (CeleBREX) CAPSULE 200MG 25152534 NDC 637 RC Facility Inpatient 200 ME 26 26 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 26 NACL 0.9% PB 50ML 264180031 NDC 258 RC Facility Inpatient 50 ML 103 103 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 78 103 D5W/0.9% NACL/20MEQ KCL IV SOLN 1000ML 264765200 NDC 258 RC Facility Inpatient 1000 ML 103 103 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 78 103 HYDROCODONE/ CHLORPHEN(TUSSIONEX) 5ML 27808008601 NDC 637 RC Facility Inpatient 5 ML 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 BISACODYL/MAG CITRATE (EVAC-Q-KWIK) KIT 281029776 NDC 637 RC Facility Inpatient 1 UN 25 25 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 25 NITROglyCERIN OINTMENT 1GM 281032608 NDC 637 RC Facility Inpatient 1 GM 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HYDROCHLOROTHIAZIDE (HCTZ) CAP 12.5MG 29300013001 NDC 637 RC Facility Inpatient 12.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ZALEPLON (SONATA) CAPSULE 5MG 29300013101 NDC 637 RC Facility Inpatient 5 ME 15 15 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 15 MONTELUKAST (SINGULAR) TABLET 10MG 29300022019 NDC 637 RC Facility Inpatient 10 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 LANSOPRAZOLE (PREVACID) 15MG CAP 300154311 NDC 637 RC Facility Inpatient 15 ME 23 23 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 23 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 18.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17.48 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 23 QUETIAPINE (SEROQUEL) TABLET 300MG 310027460 NDC 637 RC Facility Inpatient 300 ME 40 40 40 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 40 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 40 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 40 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 32 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 40 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 40 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 40 ROSUVASTATIN (CRESTOR) TABLET 10MG 310075190 NDC 637 RC Facility Inpatient 10 ME 25 25 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 25 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 25 hydrALAZINE (APPRESOLINE) TAB 100 MG 31722052201 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TorSEMIDE (DEMADEX) TABLET 20MG 31722053101 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 VALSARTAN (DIOVAN) TABLET 80MG 33342006310 NDC 637 RC Facility Inpatient 80 ME 15 15 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 15 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 15 SODIUM CHLORIDE 0.9% PB 250ML 338004802 NDC 258 RC Facility Inpatient 1 UN 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 NACL 0.9% IRRIGATION 1000 ML 338004804 NDC 258 RC Facility Inpatient 1000 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 SODIUM CHLORIDE 0.9% MB 50ML 338055311 NDC 258 RC Facility Inpatient 50 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 SODIUM CHLORIDE 0.9% PB 50ML 338055311 NDC 258 RC Facility Inpatient 50 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 NACL 0.9% MINIBAG PLUS 50ML 338055311 NDC 258 RC Facility Inpatient 50 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 D5/NS 0.02% KCL 20MEQ IV 1000ML 338066304 NDC 258 RC Facility Inpatient 20 UN 103 103 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 103 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 82.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 78.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 78 103 NITROGLYCERIN 50MG IV SOLN 250ML 338104902 NDC 258 RC Facility Inpatient 50 ME 34 34 34 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 34 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 34 NITROGLYCERIN 50MG IV SOLN 250ML 338104902 NDC 258 RC Facility Inpatient 250 ML 30 30 30 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 30 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 22 30 NOHIST-EXT ER (RELCOF)TAB 8MG/2.5MG 35573000410 NDC 637 RC Facility Inpatient 1 EA 16 16 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 16 LEVOFLOXACIN (LEVAQUIN IVPB)100ML 500MG 36000004724 NDC 250 RC Facility Inpatient 500 ME 230 230 230 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 230 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 230 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 230 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 230 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 230 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 184 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 230 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 184 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 174.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 230 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 230 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 174 230 NOREPINEPHRINE (LEVOPHED) DRIP 4MG 36000016210 NDC 258 RC Facility Inpatient 4 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 PETROLATUM WHITE JELLY 390GM 37205006927 NDC 637 RC Facility Inpatient 1 UN 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 MAGALDRATE/SIMETH (RIOPAN) SUSP 30ML 37205031440 NDC 637 RC Facility Inpatient 30 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PSEUDOEPHEDRINE (SUDAFED) TAB 30MG 37205044580 NDC 637 RC Facility Inpatient 30 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 SODIUM PHOS (FLEET ENEMA) ADULT 133ML 37205075411 NDC 637 RC Facility Inpatient 133 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BISOPROLOL/HCTZ (ZIAC) TAB 5MG/6.25MG 378050301 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BISOPROLOL FUMARATE (ZEBETA)TAB 10 MG 378052401 NDC 637 RC Facility Inpatient 10 ME 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 CLOniDINE (CATAPRES) PATCH TTS-1 378087199 NDC 637 RC Facility Inpatient 1 UN 180 180 180 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 180 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 180 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 180 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 180 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 180 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 180 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 144 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 180 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 180 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 136 180 CLONIDINE (CATAPRES) PATCH TTS-2 378087299 NDC 637 RC Facility Inpatient 1 UN 288 288 288 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 288 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 288 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 288 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 288 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 288 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 288 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 230.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 218.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 288 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 288 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 218 288 CLONIDINE (CATAPRES) PATCH TTS-3 378087399 NDC 637 RC Facility Inpatient 1 UN 376 376 376 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 376 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 376 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 376 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 376 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 376 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 300.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 376 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 300.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 285.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 376 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 376 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 285 376 DICYCLOMINE (BENTYL) CAPSULE 10MG 378161001 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CETIRIZINE (ZYRTEC) TABLET 10MG 378363701 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 METolaZONE (ZAROXOLYN) TAB 2.5MG 378617201 NDC 637 RC Facility Inpatient 2.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 VERAPAMIL (CALAN) TABLET 100 MG 378620101 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NITROglyCERIN (NITRO-BID) PATCH 2.5MG 378910293 NDC 637 RC Facility Inpatient 1 UN 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 NITROglyCERIN(NITRO-BID) PATCH 0.2MG/HR 378910493 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NITROglyCERIN (NITRO-BID) PATCH 0.6MG 378911693 NDC 637 RC Facility Inpatient 1 UN 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 DEXTROSE (GLUTOSE) ORAL GEL 15GM 38396066375 NDC 637 RC Facility Inpatient 15 GM 18 18 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 18 WINTERGREEN OIL 59ML 395166792 NDC 637 RC Facility Inpatient 1 UN 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 CLOVE OIL 395194988 NDC 637 RC Facility Inpatient 1 UN 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 PEPPERMINT OIL 395224391 NDC 637 RC Facility Inpatient 1 UN 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 CHERRY SYRUP 30ML 395266216 NDC 637 RC Facility Inpatient 30 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMMONIA NEBULE INHALANT 0.33 ML 39822990002 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HYDROcoDONE/APAP (LORTAB) 10/500MG TAB 406036362 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 OXYCOdone (IR) TABLET 5MG 406055262 NDC 637 RC Facility Inpatient 5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 HYDROMORphone (DILauDID) TABLET 2MG 406324301 NDC 637 RC Facility Inpatient 2 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 METHADONE TABLET 5MG 406575523 NDC 637 RC Facility Inpatient 5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 MORphine SULFATE ORAL CONC 20MG/ML 30ML 406800330 NDC 637 RC Facility Inpatient 20 ME 136 136 136 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 136 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 136 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 136 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 136 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 136 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 136 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 108.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 103.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 136 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 136 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 103 136 MORphine (ORAMORPH) ER TABLET 15MG 406831501 NDC 637 RC Facility Inpatient 15 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 MORPHINE (ORAMORPH SR) ER TAB 30MG 406833062 NDC 637 RC Facility Inpatient 30 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 MORphine (MS CONTIN) ER TABLET 60MG 406838001 NDC 637 RC Facility Inpatient 60 ME 18 18 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 18 OSELTAMIVIR (TAMIFLU) CAPSULE 75MG 4080085 NDC 637 RC Facility Inpatient 75 ME 52 52 52 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 52 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 52 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 52 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 52 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 52 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 52 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 41.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 52 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 52 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 52 OSELTAMIVIR (TAMIFLU)SOL 60MG/5ML 25ML 4080285 NDC 637 RC Facility Inpatient 25 ML 188 188 188 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 188 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 188 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 188 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 188 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 188 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 150.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 188 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 150.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 142.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 188 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 188 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 142 188 HYDROMORphone (DILauDID) INJ 1ML 2MG 409131230 NDC 636 RC Facility Inpatient 2 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 114.38 114.38 114.38 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 EVACUATED CONTAINER 500ML 409161403 NDC 258 RC Facility Inpatient 1 UN 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 BUTORPHANOL (STADOL) VIAL 1ML 2MG 409162601 NDC 250 RC Facility Inpatient 2 ME 39 39 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 39 HEPARIN 1000 UNITS/ML VIAL 10ML 409272002 NDC 258 RC Facility Inpatient 10000 UN 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 LIDOCAINE/EPINEPHRINE 409318202 NDC 250 RC Facility Inpatient 1 UN 20 20 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 20 WATER BACTERIOSTATIC 30ML MDV 409397703 NDC 258 RC Facility Inpatient 30 ML 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 LIDOCAINE (XYLOCAINE) 0.5% MDV 50ML 409427501 NDC 250 RC Facility Inpatient 5 ME 29 29 29 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 29 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 29 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 29 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 23.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 22 29 LIDOCAINE HCL 1% (XYLOCAINE) MDV 20ML 409427601 NDC 250 RC Facility Inpatient 20 ML 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 WATER STERILE INJECTION 20ML 409488720 NDC 258 RC Facility Inpatient 10 ML 20 20 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 20 SODIUM CHLORIDE 0.9% SYRINGE 10ML 409488810 NDC 258 RC Facility Inpatient 10 ML 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 FUROSEMIDE (LASIX) VIAL 10ML 100MG 409610210 NDC 250 RC Facility Inpatient 100 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 SODIUM BICARBONATE SYRINGE 50mEq/50ML 409663734 NDC 250 RC Facility Inpatient 50 UN 36 36 36 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 36 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 27 36 WATER STERILE FOR IRRIGATION 1000ML 409713909 NDC 258 RC Facility Inpatient 1000 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 cefTRIAXone (ROCEPHIN) VIAL 500MG 409733801 NDC 250 RC Facility Inpatient 500 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 RINGERS IV SOLN 1000ML 409795309 NDC 258 RC Facility Inpatient 1000 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 SODIUM CHLORIDE 0.45%/KCL 20MEQ 1000ML 409925739 NDC 258 RC Facility Inpatient 1000 ML 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 VENLAFAXINE (EFFEXOR ER) CAP 75MG 41616075983 NDC 637 RC Facility Inpatient 75 ME 20 20 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 20 ACETAMINOPHE/ASA/CAFF (GOODYS) HA POWDER 42037010366 NDC 637 RC Facility Inpatient 1 UN 2 2 2 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 2 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1 2 METRONIDAZOLE (FLAGYL) TABLET 500MG 42292000120 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MEPERIDINE (DEMEROL) TABLET 50MG 42806005030 NDC 637 RC Facility Inpatient 50 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 ACIDOPHILUS/LACTOBACILLUS 43292050022 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 POLYTHYLN GLYCL 3350 (MIRALAX) 17GM 43386031214 NDC 637 RC Facility Inpatient 17 GM 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PENTAZOCINE/NALOXONE (TALWIN-NX) TAB 43386068001 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 DONEPEZIL (ARICEPT) TAB 5 MG 43547027503 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CYCLObenzapRINE (FLEXERIL) TABLET 10MG 43547040010 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMOXICIL/POT CLAV(AUGMENTIN) TAB 500 MG 43598000614 NDC 637 RC Facility Inpatient 500 ME 36 36 36 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 36 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 28.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 27.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 36 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 27 36 AMOXICIL/K CLAV(AUGMENTIN XR) TAB 1000MG 43598002028 NDC 637 RC Facility Inpatient 1000 ME 16 16 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 16 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 12.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 16 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 16 DIBUCAINE 1% OINT 56GM 45802005003 NDC 637 RC Facility Inpatient 1 UN 39 39 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 39 GENTAMICIN TOPICAL CREAM 0.1% 15GM 45802005635 NDC 637 RC Facility Inpatient 1 UN 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 MUPIROCIN (BACTROBAN) OINT 22GM 45802011222 NDC 637 RC Facility Inpatient 1 UN 231 231 231 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 231 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 231 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 231 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 231 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 231 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 231 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 184.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 175.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 231 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 231 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 175 231 TRIPLE ANTIBIOTIC OINT 14.17GM 45802014301 NDC 637 RC Facility Inpatient 1 UN 24 24 24 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 24 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 24 TRIPLE ANTIBIOTIC OINT 1GM 45802014370 NDC 250 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NITROglyCERIN SPRAY 0.4MG DOSE 45802021001 NDC 637 RC Facility Inpatient 1 UN 215 215 215 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 215 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 215 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 215 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 215 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 215 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 215 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 172 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 163.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 215 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 215 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 163 215 KETOCONAZOLE SHAMPOO 45802046564 NDC 258 RC Facility Inpatient 1 UN 141 141 141 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 141 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 141 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 141 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 141 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 141 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 141 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 112.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 107.16 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 141 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 141 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 107 141 ACETAMINOPHEN (TYLENOL) SUPP 650 MG 45802073032 NDC 637 RC Facility Inpatient 650 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMINOPHEN (TYLENOL) SUPP 120 MG 45802073230 NDC 637 RC Facility Inpatient 120 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PROMETHAZINE (PHENERGAN) SUPP 12.5MG 45802075830 NDC 637 RC Facility Inpatient 12.5 ME 20 20 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 20 ESTROGEN (PREMARIN)TAB 0.625MG 46110281 NDC 637 RC Facility Inpatient 0.6 ME 14 14 14 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 14 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 14 ESTROGEN (PREMARIN) TAB 1.25MG 46110481 NDC 637 RC Facility Inpatient 1.2 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 SODIUM POLYSTYRENE SULFONATE BULK 15GM 46287000601 NDC 250 RC Facility Inpatient 15 GM 39 39 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 39 CLOTRIMAZOLE CREAM 1% 45GM 472022041 NDC 637 RC Facility Inpatient 1 UN 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 MICONAZOLE 2% VAG CRM 142GM 472073556 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MICONAZOLE(MONISTAT) VAG SUPP 100MG 472173607 NDC 637 RC Facility Inpatient 100 ME 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 ALPRAZolam (XANAX) TABLET 0.5 MG 47335060488 NDC 637 RC Facility Inpatient 0.5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 NITROFURANTOIN (MACROBID) CAPSULE 100MG 47781030301 NDC 637 RC Facility Inpatient 100 ME 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 TETRACYCLINE (SUMYCIN) CAP 250MG 47781050801 NDC 637 RC Facility Inpatient 250 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MINERAL OIL ORAL 30ML 48433020230 NDC 637 RC Facility Inpatient 30 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 RACEMIC EPINEPHRINE INH 2.25% 0.5ML 487590199 NDC 637 RC Facility Inpatient 0.5 ML 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 SODIUM CHLORIDE 0.9% INH SOL 3ML 487930103 NDC 258 RC Facility Inpatient 3 ML 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 TUBERCULIN (PPD) 5TU 0.1ML 49281075221 NDC 250 RC Facility Inpatient 0.1 ML 140 140 140 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 140 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 140 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 140 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 140 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 140 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 140 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 112 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 106.4 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 140 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 140 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 106 140 ZIPRASIDONE (GEODON) VIAL 20MG/ML 49392083 NDC 250 RC Facility Inpatient 20 ME 55 55 55 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 55 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 55 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 55 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 55 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 55 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 55 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 44 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 41.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 55 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 55 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 41 55 ASPIRIN ENTERIC COATED TABLET 81 MG 49483048112 NDC 637 RC Facility Inpatient 81 ME 2 2 2 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 2 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 1.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1.52 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 2 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1 2 LAMIVUDINE/ZIDOVUDINE (COMBIVIR) TAB 49702020218 NDC 637 RC Facility Inpatient 1 EA 59 59 59 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 59 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 47.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 44.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 59 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 44 59 DIPYRIDAMOLE/ASPIRIN (AGGRENOX) 200/25MG 49884000702 NDC 637 RC Facility Inpatient 1 UN 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 DOXYcyclINE (VIBRAMYCIN) CAPSULE 100MG 49884072703 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TRAzoDONE (DESYREL) TABLET 50MG 50111043301 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 THEOPHYLLINE (THEO-DUR) E.R TAB 200MG 50111048201 NDC 637 RC Facility Inpatient 200 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 FluoXETINE (PROZAC) CAPSULE 20MG 50111064801 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AZITHROMYCIN (ZITHROMAX) TAB 250 MG 50111078751 NDC 637 RC Facility Inpatient 250 ME 38 38 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 38 ISOSORBIDE MONONITRATE (IMDUR) TAB 30MG 50268045115 NDC 637 RC Facility Inpatient 30 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 METFORMIN (GLUCOPHAGE) XR TABLET 500MG 50268053115 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DORZOLAMIDE/TIMOL(COSOPT) OPHTH SLN 5ML 50383023310 NDC 637 RC Facility Inpatient 1 UN 632 632 632 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 632 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 632 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 632 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 632 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 632 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 505.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 632 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 632 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 505.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 480.32 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 632 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 632 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 480 632 BROMFENAC (XIBROM)OPTH 0.09% 50383024971 NDC 637 RC Facility Inpatient 1 UN 725 725 725 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 725 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 725 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 725 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 725 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 725 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 580 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 725 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 725 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 580 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 551 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 725 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 725 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 551 725 LEVOFLOXACIN (LEVAQUIN) 100MG/5ML SOL 50383028608 NDC 637 RC Facility Inpatient 25 ME 17 17 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 17 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 13.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12.92 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 17 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 17 CARBOFED DM SYRUP 5ML 50383057516 NDC 637 RC Facility Inpatient 5 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 FLUTICASONE (FLONASE) NASAL SPRAY 50MCG 50383070016 NDC 637 RC Facility Inpatient 1 UN 146 146 146 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 146 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 146 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 146 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 146 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 146 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 146 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 116.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 146 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 146 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 110 146 LIDOCAINE (XYLOCAINE) 2% VISCOUS 100ML 50383077504 NDC 637 RC Facility Inpatient 20 ME 74 74 74 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 74 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 74 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 74 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 59.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 56.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 74 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 74 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 56 74 SULFA/TMP (SEPTRA) SUSP 5ML 200-40MG 50383082316 NDC 637 RC Facility Inpatient 5 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GLYCERIN SUPPOSITORY (ADULT) 50428026926 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMINOPHEN (TYLENOL) TABLET 325 MG 50580049660 NDC 637 RC Facility Inpatient 325 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 METolaZONE (ZAROXOLYN) TAB 5MG 51079002420 NDC 637 RC Facility Inpatient 5 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 CHLORTHALIDONE (HYGROTON) TAB 25MG 51079005801 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 FuroSEMIDE (LASIX) TABLET 40MG 51079007320 NDC 637 RC Facility Inpatient 40 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MIRTAZAPINE (REMERON) TABLET 15MG 51079008656 NDC 637 RC Facility Inpatient 15 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PHENYTOIN (DILanTIN) CHEWABLE TAB 50 MG 51079012906 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMITRIPYTLINE (ELAVIL) TABLET 10 MG 51079013120 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BENAZEPRIL (LOTENSIN) TABLET 10MG 51079014501 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 BENAZEPRIL (LOTENSIN)TABLET 20MG 51079014601 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 INDOMETHACIN (INDOCIN) CAPSULE 25MG 51079019020 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 METRONIDAZOLE (FLAGYL) TABLET 250MG 51079021620 NDC 637 RC Facility Inpatient 250 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PROPRANOLOL (INDERAL) TABLET 20MG 51079027820 NDC 637 RC Facility Inpatient 20 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DIAzePAM (VALIUM) TABLET 5MG 51079028520 NDC 637 RC Facility Inpatient 5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 CLOniDINE (CATAPRES) TABLET 0.1 MG 51079029920 NDC 637 RC Facility Inpatient 0.1 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PROPOXYPHENE (DARVOCET N-100) TAB 51079032220 NDC 637 RC Facility Inpatient 100 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 chlordiazePOXIDE (LIBRIUM) CAPSULE 5MG 51079037420 NDC 637 RC Facility Inpatient 5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 chlordiazePOXIDE (LIBRIUM) CAPSULE 10MG 51079037520 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LORAZEPAM (ATIVAN) TABLET 0.5MG 51079041720 NDC 637 RC Facility Inpatient 0.5 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 TEMAZEPAM (RESTORIL) CAPSULE 30MG 51079041920 NDC 637 RC Facility Inpatient 30 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 TRIAMTERENE/HCTZ (MAXZIDE) TAB 75/50MG 51079043320 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DOxePIN (SINEQUAN) CAPSULE 25MG 51079043720 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LEVOTHYROXINE (SYNTHROID) TAB 100MCG 51079044220 NDC 637 RC Facility Inpatient 100 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LEVOTHYROXINE (SYNTHROID) TAB 125MCG 51079044301 NDC 637 RC Facility Inpatient 125 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LEVOTHYROXINE (SYNTHROID) TAB 150MCG 51079044501 NDC 637 RC Facility Inpatient 150 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 amLODIPine (NORVASC) TABLET 5 MG 51079045156 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 amLODIPine (NORVASC) TABLET 10 MG 51079045201 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 SIMVASTATIN (ZOCOR) TABLET 20MG 51079045501 NDC 637 RC Facility Inpatient 20 ME 26 26 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 26 RISPERIDONE (RISPERDAL) TABLET 1MG 51079046220 NDC 637 RC Facility Inpatient 1 ME 24 24 24 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 24 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 19.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18.24 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 24 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 24 chlorproMAZINE (THORAZINE) TAB 25MG 51079051920 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 AMITRIPTYLINE (ELAVIL) TABLET 100 MG 51079056320 NDC 637 RC Facility Inpatient 100 ME 50 50 50 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 50 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 50 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 50 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 50 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 50 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 50 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 40 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 50 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 50 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 50 THIORIDAZINE (MELLARIL) TABLET 25MG 51079056620 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ATENOLOL (TENORMIN) TABLET 50 MG 51079068401 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LOPERAMIDE (IMODIUM) CAPSULE 2MG 51079069001 NDC 637 RC Facility Inpatient 2 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ZOLPIDEM (AMBIEN) TAB 10 MG 51079072520 NDC 637 RC Facility Inpatient 10 ME 18 18 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 18 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 14.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 18 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 18 HALOPERIDOL (HALdol) TABLET 0.5MG 51079073320 NDC 637 RC Facility Inpatient 0.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HALOPERIDOL (HALdol) TABLET 1MG 51079073401 NDC 637 RC Facility Inpatient 1 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DILTIAZEM (CARDIZEM) TABLET 60MG 51079074620 NDC 637 RC Facility Inpatient 60 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DILTIAZEM HCL (CARDIZEM) TABLET 90MG 51079074720 NDC 637 RC Facility Inpatient 90 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 SUCRALFATE (CARAFATE) TABLET 1GM 51079075320 NDC 637 RC Facility Inpatient 1 GM 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ATENOLOL (TENORMIN) TAB 25 MG 51079075920 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NAPROXEN (NAPROSYN) TABLET 250MG 51079079320 NDC 637 RC Facility Inpatient 250 ME 38 38 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 38 hydrOXYzine HCL (ATARAX) TAB 25 MG 51079080620 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 glipiZIDE (GLUCOTROL) TABLET 5MG 51079081020 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CAPTOPRIL (CAPOTEN) TABLET 12.5MG 51079086301 NDC 637 RC Facility Inpatient 12.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CAPTOPRIL (CAPOTEN) TABLET 25MG 51079086420 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LAMOTRIGINE (LAMICTAL) TABLET 150MG 51079086501 NDC 637 RC Facility Inpatient 150 ME 31 31 31 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 31 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 31 glyBURIDE (DIABETA) TABLET 2.5MG 51079087220 NDC 637 RC Facility Inpatient 2.5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 glyBURIDE (DIABETA) TABLET 5MG 51079087320 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 clonazePAM (KLONOPIN) TABLET 1MG 51079088220 NDC 637 RC Facility Inpatient 1 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 METOcloPRAMIDE HCL (REGLAN) TABLET 5MG 51079088620 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PENTOXIFYLLINE (TRENTAL) TAB 400MG 51079088920 NDC 637 RC Facility Inpatient 400 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PHENYTOIN EXTENDED (DILanTIN) CAP 100MG 51079090520 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TRIAMTERENE/HCTZ (MAXZIDE) 37.5/25MG 51079093520 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TERAZOSIN (HYTRIN) CAPSULE 1MG 51079093620 NDC 637 RC Facility Inpatient 1 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 TERAZOSIN (HYTRIN) CAPSULE 5MG 51079093820 NDC 637 RC Facility Inpatient 5 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 DILTIAZEM HCL (CARDIZEM CD) ER CAP 240MG 51079094901 NDC 637 RC Facility Inpatient 240 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DILTIAZEM XR (CARDIZEM) CAPSULE 240MG 51079094901 NDC 637 RC Facility Inpatient 240 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DOXAZOSIN (CARDURA) TABLET 2MG 51079095801 NDC 637 RC Facility Inpatient 2 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LISINOPRIL (ZESTRIL) TABLET 10MG 51079098220 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 busPIRone HCL (BUSPAR) TABLET 10MG 51079098620 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TRAMADOL (ULTRAM) TABLET 50MG 51079099120 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HYOSCYAMINE SUL(LEVBID) ER TAB 0.375MG 51525011501 NDC 637 RC Facility Inpatient 0.3 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 CLOBETASOL PROPIONATE 0.05% 15 GM 51672125801 NDC 637 RC Facility Inpatient 1 UN 30 30 30 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 30 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 24 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 22.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 30 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 22 30 DESONIDE 60GM 0.05% 51672128003 NDC 637 RC Facility Inpatient 1 UN 205 205 205 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 205 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 164 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 205 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 205 "NystaTIN TOP CREAM 100,000U/GM 30GM" 51672128902 NDC 637 RC Facility Inpatient 1 UN 31 31 31 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 31 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 24.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 23.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 31 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 23 31 HYDROcortISONE VALERATE 0.2% 60GM 51672129003 NDC 637 RC Facility Inpatient 1 UN 200 200 200 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 200 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 200 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 200 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 200 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 200 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 200 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 160 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 152 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 200 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 200 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 152 200 IBUPROFEN (MOTRIN) SUSP 5ML 100MG 51672138508 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ACETAMINOPHEN (TYLENOL) SUPP 325 MG 51672211602 NDC 637 RC Facility Inpatient 325 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 NORTRIPTYLINE (PAMELOR) CAPSULE 10MG 51672400101 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GOLYTELY LIQ 4000ML 52268010001 NDC 637 RC Facility Inpatient 4000 ML 80 80 80 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 80 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 80 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 80 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 80 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 80 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 80 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 64 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 60.8 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 80 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 80 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 60 80 CHLORHEXIDINE GL (HIBICLENS) 473ml 52380127206 NDC 637 RC Facility Inpatient 473 ML 26 26 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 26 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 20.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19.76 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 26 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 26 POVIDONE-IODINE (BETADINE) SOLN 118ML 52380190504 NDC 637 RC Facility Inpatient 1 UN 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ERYTHROMYCIN BASE FILMTAB 250MG 52536018003 NDC 637 RC Facility Inpatient 250 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 PRIMIDONE (MYSOLINE) TABLET 50MG 527130101 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 TERButAline (BRETHINE) TABLET 5MG 527131101 NDC 637 RC Facility Inpatient 5 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CODEINE/ASA/BUTALB/CAFF 30/325/50/40 TAB 527131201 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 DIGOXIN (LANOXIN) TABLET 0.125MG 527132401 NDC 637 RC Facility Inpatient 0.1 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DIGOXIN (LANOXIN) TABLET 0.25MG 527132501 NDC 637 RC Facility Inpatient 0.2 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LEVOTHYROXINE (SYNTHROID) TAB 112MCG 527134601 NDC 637 RC Facility Inpatient 112 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LUBRIDERM LOTION 177ML 52800048826 NDC 637 RC Facility Inpatient 1 UN 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 CYPROHEPTADINE (PERIACTIN) TABLET 4MG 52817021010 NDC 637 RC Facility Inpatient 4 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ARTIFICIAL TEARS (REFRESH) 0.4ML 536138792 NDC 637 RC Facility Inpatient 1 UN 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 PYRIDOXINE HCL (VITA B6) 25MG TAB 536440601 NDC 637 RC Facility Inpatient 25 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CALCITRIOL (ROCALTROL) CAP 0.25 MCG 54000725 NDC 637 RC Facility Inpatient 0.2 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MORphine SULFATE IR TABLET 15MG 54023525 NDC 637 RC Facility Inpatient 15 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 MORphine SULFATE IMR TAB 15MG 54023525 NDC 637 RC Facility Inpatient 15 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 MORphine SULFATE ORAL SOLN 5ML 20MG 54040444 NDC 637 RC Facility Inpatient 10 ME 28 28 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 28 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 22.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 28 FuroSEMIDE (LASIX) TABLET 80MG 54430125 NDC 637 RC Facility Inpatient 80 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MULTIVITAMIN (MVI) INJ ADULT 10ML 54643564901 NDC 250 RC Facility Inpatient 10 ML 34 34 34 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 34 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 27.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 25.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 25 34 MULTIVITAMIN ORAL SOLN 15ML 54838000980 NDC 637 RC Facility Inpatient 15 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 THERAPEUTIC MULTIVITAMIN LIQUID 5ML 54838000980 NDC 637 RC Facility Inpatient 5 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LIDOCAINE 2% (XYLOCAINE) VISCOUS 20ML 54868182701 NDC 637 RC Facility Inpatient 20 ML 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 LEVOFLOXACIN (LEVAQUIN) TABLET 500MG 55111028050 NDC 637 RC Facility Inpatient 500 ME 11 11 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 11 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8.36 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 11 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 11 LEVOFLOXACIN (LEVAQUIN) TABLET 750MG 55111028130 NDC 637 RC Facility Inpatient 750 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ALLOPURINOL (ZYLOPRIM) TABLET 100 MG 55111072901 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 SuMAtripTAN (IMITREX) INJ 0.5ML 6MG 55150017301 NDC 637 RC Facility Inpatient 6 ME 204 204 204 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 204 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 204 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 204 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 204 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 204 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 204 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 163.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 155.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 204 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 204 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 155 204 hydrOXYzine PAMOATE (VISTARIL) CAP 50MG 555030202 NDC 636 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 114.38 114.38 114.38 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CLOTRIMAZOLE (MYCELEX) TROCHE 10MG 574010770 NDC 637 RC Facility Inpatient 10 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 SODIUM POLY SULF (SPS) SUSP 60ML 15GM 574200202 NDC 637 RC Facility Inpatient 60 ML 39 39 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 39 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 31.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 29.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 39 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 29 39 NEO/BAC/POLY (NEOSPORIN)OPHT OINT 3.5GM 574416035 NDC 637 RC Facility Inpatient 1 UN 221 221 221 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 221 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 221 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 221 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 221 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 221 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 221 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 176.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 167.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 221 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 221 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 167 221 METOPROLOL TAR (LOPRESSOR) TAB 50MG 57664047752 NDC 637 RC Facility Inpatient 50 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MULTIVITAMIN W/MINERALS TABLET 57896050101 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MAGNESIUM OXIDE (MAG-OX) TAB 400 MG 57896063412 NDC 637 RC Facility Inpatient 400 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CALCIUM CARB/VITA D (OSCAL-D)TAB 500 MG 57896074201 NDC 637 RC Facility Inpatient 500 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ASCORBIC ACID (VITAMIN C) TABLET 250 MG 57896083101 NDC 637 RC Facility Inpatient 250 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ASPIRIN ENTERIC COATED TABLET 325 MG 57896092101 NDC 637 RC Facility Inpatient 325 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HEPATITIS A VACCINE 58160083701 NDC 250 RC Facility Inpatient 0.5 ML 156 156 156 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 156 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 156 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 156 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 156 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 156 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 169.88 169.88 169.88 1 through 10 Percent of Total Billed Charges 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 156 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 124.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 118.56 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 156 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 156 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 118 156 PAPAIN/UREA OINT (ETHEZYME) 30GM 58177081602 NDC 637 RC Facility Inpatient 1 UN 110 110 110 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 110 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 110 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 110 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 110 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 110 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 110 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 88 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 83.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 110 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 110 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 83 110 RENVELA ORAL TABLET 800MG 58468013001 NDC 258 RC Facility Inpatient 800 ME 38 38 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 38 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 126.15 126.15 126.15 1 through 10 Percent of Total Billed Charges 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 30.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 28.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 38 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 28 38 ISOMETHEPT/DICHLORAL/APAP (MIDRIN) CAP 58657040101 NDC 637 RC Facility Inpatient 1 UN 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 CHLORPHENIRAMINE ER CAPSULE 12MG 58809036301 NDC 637 RC Facility Inpatient 12 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 VASOLEX (XENADERM) OINTMENT 58980078011 NDC 637 RC Facility Inpatient 1 UN 153 153 153 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 153 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 153 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 153 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 153 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 153 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 153 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 122.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 116.28 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 153 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 153 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 116 153 OXYCOdone (OXYCONTIN) ER TABLET 10MG 59011041020 NDC 637 RC Facility Inpatient 10 ME 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 OXYCOdone (OXYCONTIN) ER TABLET 20MG 59011042020 NDC 637 RC Facility Inpatient 20 ME 20 20 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 20 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 20 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 20 HYDROcoDONE/ACET(VICODIN)HS 2.5MG/500MG 591038801 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 QUININE SULFATE 260MG TAB 591071501 NDC 637 RC Facility Inpatient 260 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 buPROPion (WELLBUTRIN) XL TAB 150MG 591333130 NDC 637 RC Facility Inpatient 150 ME 9 9 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 9 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 7.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.84 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 9 MEMANTINE (NAMENDA) TABLET 10MG 591387544 NDC 637 RC Facility Inpatient 10 ME 21 21 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 21 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 16.8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 15.96 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 21 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 15 21 MEPROBAMATE(EQUANIL) 200MG TAB 591523901 NDC 637 RC Facility Inpatient 200 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CARISOPRODOL (SOMA) TABLET 350MG 591551301 NDC 637 RC Facility Inpatient 350 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 ALLOPURINOL (ZYLOPRIM) TABLET 300 MG 591554405 NDC 637 RC Facility Inpatient 300 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 MINOXIDIL TABLET 10MG 591564301 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 ATENOLOL/CHLORTHALIDONE TAB 50 / 25 MG 591578201 NDC 637 RC Facility Inpatient 1 EA 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CARBOXYMETHYLCELLULOSE (TEARS) 15ML 59390018513 NDC 637 RC Facility Inpatient 1 UN 12 12 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 12 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 9.6 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.12 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 12 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 12 ALBUTErol/IPRATROP(COMBIVENT) 1 INHALATI 597002402 NDC 637 RC Facility Inpatient 1 UN 1004 1004 1004 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 1004 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1004 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 1004 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 1004 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1004 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1004 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1004 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 803.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 763.04 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 1004 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 1004 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 763 1004 TELMISARTAN (MICARDIS) TAB 40MG 597004037 NDC 637 RC Facility Inpatient 40 ME 14 14 14 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 14 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 11.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10.64 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 14 IPRATROPIUM (ATROVENT) MDI 14.7 GM 597008717 NDC 637 RC Facility Inpatient 1 UN 913 913 913 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 913 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 913 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 913 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 913 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 913 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 730.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 913 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 913 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 730.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 693.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 913 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 913 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 693 913 DIPHENOX/ATROPINE (LOMOTIL) TAB 2.5MG 59762106101 NDC 637 RC Facility Inpatient 1 EA 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 DOXAZOSIN (CARDURA) TABLET 8MG 59762238006 NDC 637 RC Facility Inpatient 8 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 HYDROCODON/PE/CPM (CYTUSS HC) SYRUP 5ML 60258070416 NDC 637 RC Facility Inpatient 5 ML 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 POTASSIUM CL(KLOR-CON) PKT 20MEQ 603155416 NDC 637 RC Facility Inpatient 20 UN 19 19 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 19 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 15.2 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 14.44 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 19 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 14 19 HYDROCOD/PSEUDOEPHED/CPM 5ML 603160958 NDC 637 RC Facility Inpatient 5 ML 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 LIDOCAINE (LIDODERM) 5% PATCH 603188016 NDC 637 RC Facility Inpatient 1 UN 45 45 45 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 45 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 36 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 34.2 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 45 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 34 45 FIORINAL c COD (COD/APAP/BUTAL/CAF) CAP 603255321 NDC 637 RC Facility Inpatient 1 UN 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 PhenoBARBITAL TABLET 60MG 603516721 NDC 637 RC Facility Inpatient 64.8 ME 10 10 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 10 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 8 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 7.6 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 10 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 7 10 PHENYTOIN (DILanTIN) 5ML UD 125MG 60432013108 NDC 637 RC Facility Inpatient 125 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 DILTIAZEM HCL (CARDIZEM CD) TABLET 120MG 60505001406 NDC 637 RC Facility Inpatient 120 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 GABAPENTIN (NEURONTIN) CAPSULE 100MG 60505011200 NDC 637 RC Facility Inpatient 100 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 glipiZIDE (GLUCOTROL) TABLET 10MG 60505014200 NDC 637 RC Facility Inpatient 10 ME 8 8 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 8 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 6.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 6.08 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 8 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 6 8 CALCITONIN (MIACALCIN) NASAL 200 UNIT 60505082306 NDC 637 RC Facility Inpatient 1 UN 343 343 343 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 343 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 343 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 343 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 343 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 343 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 343 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 343 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 274.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 260.68 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 343 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 343 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 260 343 AMLODIPINE/BENZAPRIL(LOTREL) 5-10MG TAB 60505347803 NDC 637 RC Facility Inpatient 1 EA 13 13 13 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 13 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 13 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 13 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 10.4 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 9.88 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 13 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 13 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 9 13 FENTAnyl (DURAGESIC) PATCH 25MCG/HR 60505700600 NDC 637 RC Facility Inpatient 25 EA 75 75 75 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 75 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 75 DRG 0 Per Diem neg_dollar:$3394;There were zero instances of the item or service in the 15 months prior to posting the file 75 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 75 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 75 DRG 0 Per Diem neg_dollar:$3460;There were zero instances of the item or service in the 15 months prior to posting the file 88 1269.91 1269.91 1269.91 1 through 10 Percent of Total Billed Charges 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 75 DRG 0 Per Diem neg_dollar:$3361;There were zero instances of the item or service in the 15 months prior to posting the file 60 80 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 57 76 0 Percent of Total Billed Charges There were zero instances of the item or service in the 15 months prior to posting the file 75 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 75 100 0 Per Diem neg_dollar:$1371;There were zero instances of the item or service in the 15 months prior to posting the file 57 75 FENTAnyl (DURAGESIC) PATCH 50MCG/HR 60505700702 NDC 637 RC Facility Inpatient 50 EA 142 142 142 0 Per Diem There were zero instances of the item or service in the 15 months prior to posting the file 142 100 0 Per Diem neg_