hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|KY,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"Jane Todd Crawford Memorial Hospital, Inc.",3/31/2026,2.0.0,91Ώμ²₯,"290 Industrial Park Rd Greensburg, KY 42743",1225161524,7100030650,Richard Hendershot,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code[4],code[4]type,modifiers,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement, standard_charge|gross , standard_charge|discounted_cash ,standard_charge|Anthem | Blue Traditional / Traditional| negotiated_dollar,standard_charge|Anthem | Blue Traditional / Traditional| negotiated_percentage,standard_charge|Anthem | Blue Traditional / Traditional| negotiated_algorithm,median_amount|Anthem|Blue Traditional / Traditional,10th_percentile|Anthem|Blue Traditional / Traditional,90th_percentile|Anthem|Blue Traditional / Traditional,count|Anthem|Blue Traditional / Traditional,standard_charge|Anthem | Blue Traditional / Traditional| methodology ,additional_payer_notes | Anthem | Blue Traditional / Traditional,standard_charge|Anthem | Blue Access / Access| negotiated_dollar,standard_charge|Anthem | Blue Access / Access| negotiated_percentage,standard_charge|Anthem | Blue Access / Access| negotiated_algorithm,median_amount|Anthem|Blue Access / Access,10th_percentile|Anthem|Blue Access / Access,90th_percentile|Anthem|Blue Access / Access,count|Anthem|Blue Access / Access,standard_charge|Anthem | Blue Access / Access| methodology ,additional_payer_notes | Anthem | Blue Access / Access,standard_charge|Anthem | Blue Preferred / Preferred| negotiated_dollar,standard_charge|Anthem | Blue Preferred / Preferred| negotiated_percentage,standard_charge|Anthem | Blue Preferred / Preferred| negotiated_algorithm,median_amount|Anthem|Blue Preferred / Preferred,10th_percentile|Anthem|Blue Preferred / Preferred,90th_percentile|Anthem|Blue Preferred / Preferred,count|Anthem|Blue Preferred / Preferred,standard_charge|Anthem | Blue Preferred / Preferred| methodology ,additional_payer_notes | Anthem | Blue Preferred / Preferred,standard_charge|Anthem |Anthem Pathways| negotiated_dollar,standard_charge|Anthem | Anthem Pathways| negotiated_percentage,standard_charge|Anthem | Anthem Pathways| negotiated_algorithm,median_amount|Anthem|Anthem Pathways,10th_percentile|Anthem|Anthem Pathways,90th_percentile|Anthem|Anthem Pathways,count|Anthem|Anthem Pathways,standard_charge|Anthem | Anthem Pathways | methodology,additional_payer_notes | Anthem | Anthem Pathways,standard_charge|The First Health Network |Commerical |negotiated_dollar,standard_charge|The First Health Network | Commerical| negotiated_percentage,standard_charge|The First Health Network | Commerical| negotiated_algorithm,median_amount|The First Health Network|Commerical,10th_percentile|The First Health Network|Commerical,90th_percentile|The First Health Network|Commerical,count|The First Health Network|Commerical,standard_charge|The First Health Network | Commerical | methodology,additional_payer_notes | The First Health Network | Commerical,standard_charge|United Healthcare |Commerical |negotiated_dollar,standard_charge|United Healthcare | Commerical| negotiated_percentage,standard_charge|United Healthcare | Commerical| negotiated_algorithm,median_amount|United Healthcare|Commerical,10th_percentile|United Healthcare|Commerical,90th_percentile|United Healthcare|Commerical,count|United Healthcare|Commerical,standard_charge|United Healthcare | Commerical | methodology,additional_payer_notes | United Healthcare | Commerical,standard_charge|min,standard_charge|max,additional_generic_notes
OPTIRAY 320 50ML,171887-3,CDM,250,RC,Q9965,HCPCS,19132306,NDC,,,BOTH,,,49.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OPTIRAY 320 100ML,171888-1,CDM,250,RC,Q9959,HCPCS,19132311,NDC,,,BOTH,,,97.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISONE 10MG-HIKM,70471-8,CDM,250,RC,J7506,HCPCS,54001720,NDC,,,BOTH,,,2.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHFLO,172082-0,CDM,250,RC,J2997,HCPCS,50242004164,NDC,,,BOTH,,,214.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENTIOLAMINE MES 5MG,179541-8,CDM,250,RC,J2760,HCPCS,143956401,NDC,,,BOTH,,,1374.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTOPAM 1GM VIAL,179540-0,CDM,250,RC,J2730,HCPCS,60977014101,NDC,,,BOTH,,,1459.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAZICEF 1GM ADDVANT,171823-8,CDM,250,RC,J0713,HCPCS,409509216,NDC,,,BOTH,,,8.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAZICEF 2GM ADDVANT,179959-2,CDM,250,RC,J0713,HCPCS,409509311,NDC,,,BOTH,,,8.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFIPIME 2GM,172084-6,CDM,250,RC,J0692,HCPCS,60505614704,NDC,,,BOTH,,,47.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFAZOLIN 500MG INJ,172083-8,CDM,250,RC,J0690,HCPCS,60505614200,NDC,,,BOTH,,,7.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAL. GLUC 1 GM./10ML,70229-0,CDM,250,RC,J0610,HCPCS,63323036019,NDC,,,BOTH,,,28.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUTORPHANOL 1MG INJ,172078-8,CDM,250,RC,J0595,HCPCS,409162601,NDC,,,BOTH,,,6.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOLIC ACID 1 MG,70679-6,CDM,250,RC,,,62584089701,NDC,,,BOTH,,,1.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL INH 200PUF,172321-2,CDM,250,RC,,,66993001968,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACCU-CHECK INFORM II,172040-8,CDM,250,RC,,,65702042810,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMIN 120MG SUPP,70001-3,CDM,250,RC,,,45802073230,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN 500MG,179415-5,CDM,250,RC,,,904673061,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACIDOPHILUS/BULGA TA,70926-1,CDM,250,RC,,,64980012950,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL SU INH 60P,172518-3,CDM,250,RC,,,173068224,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLOPURINOL 100MG,71755-3,CDM,250,RC,,,904704161,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIODORONE 200MG,72032-6,CDM,250,RC,,,60687043711,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMITRIPTYLINE 10MG,70509-5,CDM,250,RC,,,16729017101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMITRIPTYLINE 25MG,70510-3,CDM,250,RC,,,60687043301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMLODIPINE 5MG TAB,179156-5,CDM,250,RC,,,60687045801,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMMONIA STICK/EA,70116-9,CDM,250,RC,,,39822990001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOXICILLIN 250MG/5M,70112-8,CDM,250,RC,,,143988980,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTACID TAB-GUARDIAN,179199-5,CDM,250,RC,,,24385048547,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APAP/ASA/CAF250/65,179414-8,CDM,250,RC,,,536132601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APAP/CODEINE 300/30,71594-6,CDM,250,RC,,,406048462,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 81MG EC-MAJO,172611-6,CDM,250,RC,,,904678370,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 325MG TAB-MGR,179250-6,CDM,250,RC,,,536105429,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATORVASTATIN 10MG MY,179298-5,CDM,250,RC,,,51079020820,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATORVASTATIN 10MG T,172190-1,CDM,250,RC,,,68084009701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATORVASTATIN 40MG-AV,179253-0,CDM,250,RC,,,50268009515,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B12 1000MCG TAB,179184-7,CDM,250,RC,,,77333093825,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BD LACTINEX TAB,179282-9,CDM,250,RC,,,8290236850,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETADINE 10% SOL,72874-1,CDM,250,RC,,,67618015017,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISACODYL 5MG TAB,70438-7,CDM,250,RC,,,904792760,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISMUTH SUBSALI 30ML,71920-3,CDM,250,RC,,,904131309,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISMUTH SUBSALICYLAT,172640-5,CDM,250,RC,,,536128636,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPROPION SA 150MG,72319-7,CDM,250,RC,,,68084070825,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM CARB SUSP5CC,179688-7,CDM,250,RC,,,54311763,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM CARBON 500MG,172299-0,CDM,250,RC,,,66553000401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM CITRATE 950M,179461-9,CDM,250,RC,,,80681014000,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM D,71957-5,CDM,250,RC,,,10006070038,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM/VIT D600/400,179462-7,CDM,250,RC,,,77333011510,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBAMAZEPINE 100MG,72884-0,CDM,250,RC,,,904385461,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CENTRUM GENERIC LIQ,72294-2,CDM,250,RC,,,69618000858,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHARCOAL/SORBITOL5ML,719105-9,CDM,250,RC,,,574052076,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHARCOAL/WATER 5ML,719106-7,CDM,250,RC,,,574052176,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORDIAZEPOXIDE 25MG,70941-0,CDM,250,RC,,,555015904,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORDIAZEPOXIDE 5MG,70939-4,CDM,250,RC,,,555015802,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORDIAZEPOXIDE10MG,179441-1,CDM,250,RC,,,51079037520,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINDAMYCIN 150MG,70273-8,CDM,250,RC,,,68084024311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE 0.1MG TAB,339-2,CDM,250,RC,,,60687011311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE 0.1MG TAB,70242-3,CDM,250,RC,,,60687011311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE 0.1MG TAB,187-5,CDM,250,RC,,,60687011311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE 0.1MG-BLUE,179136-7,CDM,250,RC,,,68001023700,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYBURIDE MICRO 3MG,729012-5,CDM,250,RC,,,93803501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COENZYME Q-10 100MG,179431-2,CDM,250,RC,,,80681001000,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRANBERRY 400MG TAB,179520-2,CDM,250,RC,,,57896084501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAIRY RELIEF-RAPITAN,179201-9,CDM,250,RC,,,46122014866,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAKIN'S 1/4TH SOL-CE,172695-9,CDM,250,RC,,,436067216,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAKIN'S FULL-CENTURY,179174-8,CDM,250,RC,,,436094616,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAKINS 1/2 STR 0.25%,179183-9,CDM,250,RC,,,436093616,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETH 5ML,70361-1,CDM,250,RC,,,54317763,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM 2MG,71658-9,CDM,250,RC,,,51079028420,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM 5MG,71659-7,CDM,250,RC,,,51079028520,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM CD 120MG,70466-8,CDM,250,RC,,,60687020601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM 30MG,70239-9,CDM,250,RC,,,60687056201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM CD 180MG,72483-1,CDM,250,RC,,,60687020601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM-OCEAN-30MG,172672-8,CDM,250,RC,,,68682000610,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE 25MG,70157-3,CDM,250,RC,,,904530661,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE-BTL,179328-0,CDM,250,RC,,,24385037926,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE NA 100MG,70280-3,CDM,250,RC,,,904645561,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE SOD 100MG,172677-7,CDM,250,RC,,,69618004401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE SOD 100MG C,172625-6,CDM,250,RC,,,904718361,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE SOD 100MG C,179102-9,CDM,250,RC,,,904699880,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE SOD 250MG C,172535-7,CDM,250,RC,,,536106401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXEPIN 10MG,71423-8,CDM,250,RC,,,51079043620,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DUO NEB (IPRAT ALB),172376-6,CDM,250,RC,,,60687040583,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EGESTROL 40MG-MAJOR,179185-4,CDM,250,RC,,,77333093825,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 20MG-AHP,172593-6,CDM,250,RC,,,60687059501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 20MG-RUGB,179231-6,CDM,250,RC,,,536129801,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEOSOL 45MG TAB,172042-4,CDM,250,RC,,,46017009660,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEOSOL ORIGINAL TAB,172627-2,CDM,250,RC,,,46017009712,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEROCON,72556-4,CDM,250,RC,,,51991063501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEROSUL 325MG TAB-MA,179274-6,CDM,250,RC,,,904759160,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FERROUS SULF 325MG,172041-6,CDM,250,RC,,,904759161,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FERROUS SULFATE 325,179294-4,CDM,250,RC,,,57896070310,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBERCON TAB,70687-9,CDM,250,RC,,,536430611,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FISH OIL 1000MG CAP,179475-9,CDM,250,RC,,,904723860,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLINTSTONE CHEWABLE,179396-7,CDM,250,RC,,,16500009713,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUORESCEIN 2% STRIP,70677-0,CDM,250,RC,,,17238090011,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 20MG TAB,70976-6,CDM,250,RC,,,51079007201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG TAB,70936-0,CDM,250,RC,,,51079007320,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN 100MG,72021-9,CDM,250,RC,,,60687058001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN 300MG-MAJ,172638-9,CDM,250,RC,,,904666661,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN 400MG CAP,172639-7,CDM,250,RC,,,904666761,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAS RELIEF 80MG TAB,172636-3,CDM,250,RC,,,24385011878,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIPIZIDE 5MG,70727-3,CDM,250,RC,,,51079081020,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIPIZIDE 5MG TAB-AV,179216-7,CDM,250,RC,,,50268036115,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIPIZIDE 5MG-APOTEX,179221-7,CDM,250,RC,,,60505014100,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCERINE ADULT,70723-2,CDM,250,RC,,,132007924,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUAIFENESIN 100/5ML,179272-0,CDM,250,RC,,,121174405,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUAIFENESIN 200MG UD,172281-8,CDM,250,RC,,,121148810,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H-CHLOR 0.062% 5ML,172435-0,CDM,250,RC,,,39328006506,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H-CHLOR 0.125% 5ML,172436-8,CDM,250,RC,,,39328006412,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL 0.5MG,70788-5,CDM,250,RC,,,51079073320,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL 1MG,70752-1,CDM,250,RC,,,51079073420,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCTZ 25MG,70771-1,CDM,250,RC,,,16729018301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN FLUSH 100U/M,171821-2,CDM,250,RC,,,8290306424,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIBICHENS 4%,70762-0,CDM,250,RC,,,234057508,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIGH POTENCY MULTVIT,172580-3,CDM,250,RC,,,80681016000,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDRALAZINE 10MG TAB,70068-2,CDM,250,RC,,,68084044701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDRALAZINE 25MG,70069-0,CDM,250,RC,,,904644161,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDRALAZINE 25MG-AHP,179226-6,CDM,250,RC,,,62584073301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCHL 25MG-AHP,179119-3,CDM,250,RC,,,60687059301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 5MG,171885-7,CDM,250,RC,,,59762007301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROGEN PEROXIDE,70773-7,CDM,250,RC,,,46122033443,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE 10MG TAB,70090-6,CDM,250,RC,,,68084025301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE 25MG TAB,70091-4,CDM,250,RC,,,68084025401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE 25MG-MAJ,179237-3,CDM,250,RC,,,904661761,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE PAMOATE,71675-3,CDM,250,RC,,,68084084711,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYSEPT 0.25% 5ML,172437-6,CDM,250,RC,,,39328006325,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYSEPT 0.5% 5ML,172438-4,CDM,250,RC,,,39328006250,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
I-VITE TAB,172453-3,CDM,250,RC,,,536509008,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBUPROFEN 200MG,72881-6,CDM,250,RC,,,904791461,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBUPROFEN 600MG,71075-6,CDM,250,RC,,,60687045711,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INDOMETHACIN 25MG,70812-3,CDM,250,RC,,,50268043015,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IPRATROPIUM NEBS,72145-6,CDM,250,RC,,,60687039483,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISONIOZID 100MG,171804-8,CDM,250,RC,,,555006602,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOSORBIDE MN 20MG,71928-6,CDM,250,RC,,,62175010701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K-PHOS 500MG,171947-5,CDM,250,RC,,,486111101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETAMINE 10MG/ML I,172091-1,CDM,250,RC,,,67457018120,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTOBACILLUS TAB UD,179400-7,CDM,250,RC,,,77333044110,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAMOTRIGINE 25MG,172184-4,CDM,250,RC,,,68084031801,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTH 25MCG TAB-AHP,179247-2,CDM,250,RC,,,60687045301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 25MCG,172240-4,CDM,250,RC,,,60687045301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 50MCGT,172623-1,CDM,250,RC,,,60687046401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 88MCG,70469-2,CDM,250,RC,,,42292003820,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISINOPRIL 20MG,71344-6,CDM,250,RC,,,60687033311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISINOPRIL 20MG-MAJO,172675-1,CDM,250,RC,,,904679961,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISINOPRIL 5MG T-MAJ,172588-6,CDM,250,RC,,,904679701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LITHIUM 150MG,70597-0,CDM,250,RC,,,54852625,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LITHIUM 300MG,72358-5,CDM,250,RC,,,54852725,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LITHIUM CR 450MG,71970-8,CDM,250,RC,,,54002025,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOPERAMIDE 1MG/5ML,172326-1,CDM,250,RC,,,904683620,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 0.5MG,70121-9,CDM,250,RC,,,591024010,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 0.5MG-AHP,172603-3,CDM,250,RC,,,60687040101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 0.5MG-MAJ,172602-5,CDM,250,RC,,,904600761,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 1MG-AHP,179207-6,CDM,250,RC,,,60687035501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAG OXIDE 400MG-MAJO,172614-0,CDM,250,RC,,,10006070028,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNESIUM OXIDE 400M,72327-0,CDM,250,RC,,,64980033901,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDROXYPRO 2.5MG TAB,179105-2,CDM,250,RC,,,59762005501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MELATONIN 3MG TAB,172423-6,CDM,250,RC,,,50268052415,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MELATONIN 3MG-PRECIS,172604-1,CDM,250,RC,,,68094011059,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METFORMIN500MG-MAJOR,179171-4,CDM,250,RC,,,904716261,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHIMAZOLE 5MG,172024-2,CDM,250,RC,,,23155007001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHOCARBAMOL 500MG,71363-6,CDM,250,RC,,,60687055901,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOCLO5MG/5MLPHARMA,179170-6,CDM,250,RC,,,121057616,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL 25MG,72821-2,CDM,250,RC,,,51079025520,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL 50MG,70957-6,CDM,250,RC,,,51079080120,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL TARTRATE,172618-1,CDM,250,RC,,,62584026501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL TA 50MG T,172678-5,CDM,250,RC,,,62584026601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METRONIDAZOLE 250MGT,70607-7,CDM,250,RC,,,904145361,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONTELUKAST 10MG TAB,172287-5,CDM,250,RC,,,904680861,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MULTIVITAMIN W/MIN,71539-1,CDM,250,RC,,,904549261,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
N-ACETYL CYSTEINE600M,179375-1,CDM,250,RC,,,40093010084,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSPORIN U/DGENERIC,72869-1,CDM,250,RC,,,45802014370,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPHRONEX 5ML,172465-7,CDM,250,RC,,,54859051608,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOREPINEPHRIN 4MG PM,179523-6,CDM,250,RC,,,44567064010,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS 1000ML IRRIGATION,719021-8,CDM,250,RC,,,338004804,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS 500ML IRRIGATION,719022-6,CDM,250,RC,,,409613803,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN ORAL-BOTTLE,179329-8,CDM,250,RC,,,66689000802,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSCAL TAB,71214-1,CDM,250,RC,,,904188361,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE 5MG,72105-0,CDM,250,RC,,,406055262,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PANTOPRAZOLE SOD 40M,172542-3,CDM,250,RC,,,68084081309,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 100MG CAP,70405-6,CDM,250,RC,,,68084037601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOS-NAK CONC PWD P,172439-2,CDM,250,RC,,,60258000615,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PINK BISMUTH 262MG T,179154-0,CDM,250,RC,,,904131546,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PINK BISMUTH TAB-GU,179103-7,CDM,250,RC,,,24385002465,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POT CHL 8MEQ TAB-BLK,179299-3,CDM,250,RC,,,832532211,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM 10 TAB,172018-4,CDM,250,RC,,,245531701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISONE 1MG,719062-2,CDM,250,RC,,,54873925,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISONE 20MG,70374-4,CDM,250,RC,,,60687014501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISONE 5MG,70373-6,CDM,250,RC,,,54872425,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROBIOTIC BLEND C-NB,172606-6,CDM,250,RC,,,79854073540,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROBIOTIC FORMULA C,172478-0,CDM,250,RC,,,536105907,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 12.5MG,179675-4,CDM,250,RC,,,68084015401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MGT-A,179116-9,CDM,250,RC,,,68084015501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE DM 5ML,71250-5,CDM,250,RC,,,60432060416,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPRANOLOL 20MG,70856-0,CDM,250,RC,,,50268070115,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSEUDOEPHED 120MG,71461-8,CDM,250,RC,,,45802010752,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSEUDOEPHED 60MG,71460-0,CDM,250,RC,,,904672852,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSYLLIUM FIBER PACK,172198-4,CDM,250,RC,,,37000002304,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PYRODOXINE 50MG,71307-3,CDM,250,RC,,,77333094010,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUINIDINE SULF/200 MG,71332-1,CDM,250,RC,,,185434601,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REPAGLINIDE 0.5MG,172523-3,CDM,250,RC,,,574024001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENNA-DOCU 8.6-50MGT,179104-5,CDM,250,RC,,,60687062201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENNA/DOCUSATE SOD,172283-4,CDM,250,RC,,,536124801,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SERTRALINE 50MG TAB,171799-0,CDM,250,RC,,,60687024211,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMETHICONE 80MG,71099-6,CDM,250,RC,,,904506860,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLOW-MAG,71981-5,CDM,250,RC,,,67618010760,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMZ/TMP DS TAB,71409-7,CDM,250,RC,,,60687053101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHL 1GM TAB,179336-3,CDM,250,RC,,,77333083510,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CITRATE 10G/250,179376-9,CDM,250,RC,,,942950625,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CITRATE 20G/500,171927-7,CDM,250,RC,,,942950410,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM BICARB 650MG,71774-4,CDM,250,RC,,,77333083125,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHL 3NEB 3ML,72870-9,CDM,250,RC,,,487930103,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHLORIDE TAB,71484-0,CDM,250,RC,,,223176001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SORE THROAT LOGENGES,179938-6,CDM,250,RC,,,904625549,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIRONOLACTONE 25MG,70020-3,CDM,250,RC,,,60687046511,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOOLSOFTENER250-MAJ,179193-8,CDM,250,RC,,,904699960,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STRESSTAB 600 C FE,71456-8,CDM,250,RC,,,5412619,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCRALFATE 1GM,70234-0,CDM,250,RC,,,51079075320,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUDAFED CHD 15MG/5ML,172556-3,CDM,250,RC,,,50580053604,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUDOGEST 30MG TAB,172505-0,CDM,250,RC,,,904505359,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFASALAZINE 500MG,171940-0,CDM,250,RC,,,59762010401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIAMINE 100MG TAB,72310-6,CDM,250,RC,,,77333093410,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIORIDAZINE 10MG,71023-6,CDM,250,RC,,,51079056520,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAM/HCTZ 37.5/25,171793-3,CDM,250,RC,,,72578009001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMT/HCTZ 37.5MG,172664-5,CDM,250,RC,,,72578009001,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIHEXYPHENIDYL 2MG,70079-9,CDM,250,RC,,,591533501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIHEXYPHENIDYL 5MG,70080-7,CDM,250,RC,,,591533701,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYLENOL #3 SPECGX,172301-4,CDM,250,RC,,,406048462,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYLENOL 325MG,719024-2,CDM,250,RC,,,50580045811,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYLENOL 500MG TABLET,393-9,CDM,250,RC,,,904672040,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALPROIC 250/5-PHARM,179125-0,CDM,250,RC,,,121467500,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIT D 5000IU CAP-N13,179215-9,CDM,250,RC,,,74312019377,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B COMPLEX,72014-4,CDM,250,RC,,,43292055540,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B12 100MCG,719094-5,CDM,250,RC,,,904113213,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B12 100MCG T,172680-1,CDM,250,RC,,,50268085215,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN C 500MG-GNP,172648-8,CDM,250,RC,,,87701040741,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN C 500MG/15ML,179356-1,CDM,250,RC,,,69618001854,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 2000U,171963-2,CDM,250,RC,,,50268086715,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 400UNITS,72209-0,CDM,250,RC,,,904582360,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 5000U,171860-0,CDM,250,RC,,,50268086815,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D3 1000 IU T,172404-6,CDM,250,RC,,,20555003300,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D3 2000IU-RU,172673-6,CDM,250,RC,,,80681000900,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN E 1000IU-MAJ,172686-8,CDM,250,RC,,,904027760,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN E 200IU-RUGB,172661-1,CDM,250,RC,,,80681015900,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN 1MG,72141-5,CDM,250,RC,,,832121101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN 2MG,70306-6,CDM,250,RC,,,832121201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN SODIUM 5MGT,70308-2,CDM,250,RC,,,62584099401,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
YUPELRI 175MCG INH,179563-2,CDM,250,RC,,,49502080693,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC OXIDE 20% 454G,179310-8,CDM,250,RC,,,536131698,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC SULFATE 220MG,72026-8,CDM,250,RC,,,77333098310,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLPIDEM 5MG,72303-1,CDM,250,RC,,,904608261,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOCLOPRAMIDE 10MG,179725-7,CDM,250,RC,,,121157610,NDC,,,BOTH,,,1.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREPARATION H SUPP,172245-3,CDM,250,RC,,,573288311,NDC,,,BOTH,,,1.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE LIQ 5ML,71248-9,CDM,250,RC,,,121092716,NDC,,,BOTH,,,1.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIFEDIPINE 30MG SA,172610-8,CDM,250,RC,,,50268059715,NDC,,,BOTH,,,1.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPRAZOLAM .25MG,71726-4,CDM,250,RC,,,51991070401,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DICYCLOMINE 10MG,70163-1,CDM,250,RC,,,60687036901,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KLOR-CON 8MEQ TAB,171814-7,CDM,250,RC,,,245531501,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 2% 100ML-A,179222-5,CDM,250,RC,,,50383077504,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPHROCAP (RENAL CAP,172365-9,CDM,250,RC,,,63044062201,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN 2.5MG,70307-4,CDM,250,RC,,,832121301,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN 3MG-JANTOVE,172577-9,CDM,250,RC,,,832121401,NDC,,,BOTH,,,1.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPHROCAPS GENERIC,72124-1,CDM,250,RC,,,60258016201,NDC,,,BOTH,,,1.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAHIST AD PSE TAB,179384-3,CDM,250,RC,,,58407062530,NDC,,,BOTH,,,1.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL 1MG,70559-0,CDM,250,RC,,,51862033301,NDC,,,BOTH,,,1.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL 20MEQ,70906-3,CDM,250,RC,,,245531901,NDC,,,BOTH,,,1.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIAL 1MG T-EPIC,179147-4,CDM,250,RC,,,42806008801,NDC,,,BOTH,,,1.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISINOPRIL 2.5MG,179680-4,CDM,250,RC,,,68084076521,NDC,,,BOTH,,,1.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEGESTROL 20MG,72493-0,CDM,250,RC,,,49884028901,NDC,,,BOTH,,,1.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENICILLIN 250MG TAB,171852-7,CDM,250,RC,,,781120501,NDC,,,BOTH,,,1.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENOXYLATE/ATROP,70956-8,CDM,250,RC,,,62559049001,NDC,,,BOTH,,,1.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LABETALOL 200MG,70497-3,CDM,250,RC,,,60687045001,NDC,,,BOTH,,,1.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOCUSATE NA 100/10ML,70281-1,CDM,250,RC,,,121054410,NDC,,,BOTH,,,1.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEPHALEXIN 250MG,70884-2,CDM,250,RC,,,60687015201,NDC,,,BOTH,,,1.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE 20MG/ML LIQ,172282-6,CDM,250,RC,,,406800312,NDC,,,BOTH,,,1.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AVEENO BATH,719116-6,CDM,250,RC,,,8137003640,NDC,,,BOTH,,,1.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM ACETATE 667M,179887-5,CDM,250,RC,,,69097086283,NDC,,,BOTH,,,1.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMIPRAMINE 25MG,71563-1,CDM,250,RC,,,69315013401,NDC,,,BOTH,,,1.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOCLOPRAMIDE 10MGT,71354-5,CDM,250,RC,,,68084067611,NDC,,,BOTH,,,1.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 50000U,179829-7,CDM,250,RC,,,69452015120,NDC,,,BOTH,,,1.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METFORMIN 500MG,71965-8,CDM,250,RC,,,60687015511,NDC,,,BOTH,,,1.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZONATATE 100MG,71918-7,CDM,250,RC,,,60687034601,NDC,,,BOTH,,,1.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZONATATE 100MG CA,172637-1,CDM,250,RC,,,68084021401,NDC,,,BOTH,,,1.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLURAZEPAM 15MG,70351-2,CDM,250,RC,,,378441501,NDC,,,BOTH,,,1.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 250MG T,172642-1,CDM,250,RC,,,904670808,NDC,,,BOTH,,,1.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACLOFEN 10 MG,70218-3,CDM,250,RC,,,68084085501,NDC,,,BOTH,,,1.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METFORMIN XR 500MG,72396-5,CDM,250,RC,,,62756014201,NDC,,,BOTH,,,1.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUAIFENESIN AC,172279-2,CDM,250,RC,,,121177505,NDC,,,BOTH,,,1.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERAPAMIL 120MG,71708-2,CDM,250,RC,,,904292461,NDC,,,BOTH,,,1.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SILVER NITRATE STICK,71499-8,CDM,250,RC,,,12870000101,NDC,,,BOTH,,,1.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIORIDAZINE 25MG,71024-4,CDM,250,RC,,,51079056620,NDC,,,BOTH,,,1.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUSPIRONE 5MG,70215-9,CDM,250,RC,,,64380074106,NDC,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUSPIRONE 5MGUNICHEM,179205-0,CDM,250,RC,,,29300024401,NDC,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCITRIOL 0.25MCG C,172140-6,CDM,250,RC,,,60687034501,NDC,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE B/ACE7.5,72492-2,CDM,250,RC,,,60687040701,NDC,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENEPROTEIN UD,179556-6,CDM,250,RC,,,43900028430,NDC,,,BOTH,,,1.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBIDOPA/LEVODO 10,71420-4,CDM,250,RC,,,51862085501,NDC,,,BOTH,,,1.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DONEPEZIL 5MG-AHP,172597-7,CDM,250,RC,,,60687029201,NDC,,,BOTH,,,1.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAPROXEN 250MG,71127-5,CDM,250,RC,,,68462018801,NDC,,,BOTH,,,1.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM 25MG/5M-AT,172591-0,CDM,250,RC,,,70860030105,NDC,,,BOTH,,,1.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYBURIDE 5MG,70455-1,CDM,250,RC,,,93936401,NDC,,,BOTH,,,1.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 125MG/5ML,171822-0,CDM,250,RC,,,51672406901,NDC,,,BOTH,,,1.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE/AP 5/325,72491-4,CDM,250,RC,,,406012362,NDC,,,BOTH,,,1.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIOTHYRONINE 50MCG,179525-1,CDM,250,RC,,,62756058988,NDC,,,BOTH,,,1.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN 325MGS,70002-1,CDM,250,RC,,,51672211602,NDC,,,BOTH,,,1.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CH 20MEG T,172644-7,CDM,250,RC,,,68084036009,NDC,,,BOTH,,,1.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCHLORPERAZINE5MGT,70287-8,CDM,250,RC,,,50268068415,NDC,,,BOTH,,,1.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 112MCG,72299-1,CDM,250,RC,,,60687050801,NDC,,,BOTH,,,1.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAMADOL 50MG,71949-2,CDM,250,RC,,,68084080801,NDC,,,BOTH,,,1.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZIHE SYRUP,70089-8,CDM,250,RC,,,60432015004,NDC,,,BOTH,,,1.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MILK MAGNESIA 1OZ,71049-1,CDM,250,RC,,,121043130,NDC,,,BOTH,,,1.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TORSEMIDE 20MG,71923-7,CDM,250,RC,,,68084053901,NDC,,,BOTH,,,1.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXEPIN 25MG,71424-6,CDM,250,RC,,,51079043720,NDC,,,BOTH,,,1.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCERIN PED SUPP,179313-2,CDM,250,RC,,,58980040912,NDC,,,BOTH,,,1.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYOSCYAMINE 0.125MG,72494-8,CDM,250,RC,,,42192033901,NDC,,,BOTH,,,1.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METFORMINER500-GRANU,179168-0,CDM,250,RC,,,70010049101,NDC,,,BOTH,,,1.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL MDI 1 DOSE,171876-6,CDM,250,RC,,,173068224,NDC,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATORVASTATION 40MG,172191-9,CDM,250,RC,,,68084009901,NDC,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBIDOPA/LEVODOPA25,71422-0,CDM,250,RC,,,904623861,NDC,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DICLOXACLIIIN 250MGC,172020-0,CDM,250,RC,,,93312301,NDC,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MECLIZINE 25MG,70062-5,CDM,250,RC,,,68084049101,NDC,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBUPROFEN LIQUID,72777-6,CDM,250,RC,,,68094049459,NDC,,,BOTH,,,2.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISINOPRIL 5MG,70693-7,CDM,250,RC,,,68084019601,NDC,,,BOTH,,,2.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOPERAMIDE 2MG,70806-5,CDM,250,RC,,,60687022911,NDC,,,BOTH,,,2.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE 20MG/5ML LQ,171960-8,CDM,250,RC,,,54023849,NDC,,,BOTH,,,2.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIMEPIRIDE 2MG TAB,72809-7,CDM,250,RC,,,68084032601,NDC,,,BOTH,,,2.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 1MG-TEVA,179251-4,CDM,250,RC,,,93342601,NDC,,,BOTH,,,2.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDODRINE 5MG TAB,179861-0,CDM,250,RC,,,60687039801,NDC,,,BOTH,,,2.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPYLTHIOURACIL50MG,71292-7,CDM,250,RC,,,67253065110,NDC,,,BOTH,,,2.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PTU ACTAVIS 50MG,179111-0,CDM,250,RC,,,228234810,NDC,,,BOTH,,,2.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOCLOPRAMIDE 5MG,72883-2,CDM,250,RC,,,51079088620,NDC,,,BOTH,,,2.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METRONIDAZOLE 500MGT,72271-0,CDM,250,RC,,,60687055011,NDC,,,BOTH,,,2.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPAFENONE150MG-AHP,179139-1,CDM,250,RC,,,60687053701,NDC,,,BOTH,,,2.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBIDOPA/LEVODO 25,71421-2,CDM,250,RC,,,51079097820,NDC,,,BOTH,,,2.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBUPROFEN SUSP 100MG,179217-5,CDM,250,RC,,,68094060062,NDC,,,BOTH,,,2.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENAZEPRIL 10MG,72877-4,CDM,250,RC,,,50268011015,NDC,,,BOTH,,,2.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUCINEX DM,179925-3,CDM,250,RC,,,63824005632,NDC,,,BOTH,,,2.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD.CHL.INH.15ML-RD,179182-1,CDM,250,RC,,,76204030050,NDC,,,BOTH,,,2.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONDANSETRON 8MG TAB,179676-2,CDM,250,RC,,,68084022111,NDC,,,BOTH,,,2.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONDANSETRON 8MG TAB,371-5,CDM,250,RC,,,68084022111,NDC,,,BOTH,,,2.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONDANSETRON 8MG TAB,208-9,CDM,250,RC,,,68084022111,NDC,,,BOTH,,,2.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHLO 0.9%ONH15ML,179912-1,CDM,250,RC,,,378698789,NDC,,,BOTH,,,2.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM ACETATE 2MEQ,172399-8,CDM,250,RC,,,409729973,NDC,,,BOTH,,,2.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTULOSE 30CC,72566-3,CDM,250,RC,,,121115430,NDC,,,BOTH,,,2.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEMANTINE 10MG,179653-1,CDM,250,RC,,,904650661,NDC,,,BOTH,,,2.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MG,71255-4,CDM,250,RC,,,904648161,NDC,,,BOTH,,,2.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROSPIUM 20MG TAB-US,179302-5,CDM,250,RC,,,574014560,NDC,,,BOTH,,,2.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXAZOSIN 2MG,70463-5,CDM,250,RC,,,904552361,NDC,,,BOTH,,,2.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINERAL OIL OZ,71050-9,CDM,250,RC,,,48433020203,NDC,,,BOTH,,,2.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYAMBUTOL 400MG,71081-4,CDM,250,RC,,,68850001201,NDC,,,BOTH,,,2.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACARBOSE 50MG,172271-9,CDM,250,RC,,,54014125,NDC,,,BOTH,,,2.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULINDAC150MGTAB-EPI,179140-9,CDM,250,RC,,,42806001801,NDC,,,BOTH,,,2.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULINDAC 150MG,70269-6,CDM,250,RC,,,591566101,NDC,,,BOTH,,,2.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KCL 10MEQ ER CAP-BP,179238-1,CDM,250,RC,,,68001039600,NDC,,,BOTH,,,2.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM 30MG-TEVA,179232-4,CDM,250,RC,,,93031801,NDC,,,BOTH,,,2.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUAIFENESIN LA 600MG,179932-9,CDM,250,RC,,,68084057201,NDC,,,BOTH,,,2.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RACEPINEPHRINE 2.5%,71467-5,CDM,250,RC,,,487278401,NDC,,,BOTH,,,2.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALUM HYD/MAG HYD,72568-9,CDM,250,RC,,,121176130,NDC,,,BOTH,,,2.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL 10MEQC,172526-6,CDM,250,RC,,,904693061,NDC,,,BOTH,,,2.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM ACET 667MG-S,179145-8,CDM,250,RC,,,24689079302,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUMACE667-RISING,179188-8,CDM,250,RC,,,16571081320,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYCERIN SL 0.4,172227-1,CDM,250,RC,,,68462063945,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYCERIN SL 0.4,395-4,CDM,250,RC,,,68462063945,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYCERIN SL 0.4,206-3,CDM,250,RC,,,68462063945,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAMADOLAPAP37.5/325,172379-0,CDM,250,RC,,,53746061701,NDC,,,BOTH,,,2.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLEET ENEMA-GENERIC,171830-3,CDM,250,RC,,,536741551,NDC,,,BOTH,,,2.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROBID 6.5MG CAP,71157-2,CDM,250,RC,,,49483022210,NDC,,,BOTH,,,2.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIRTAZAPINE 15MG AHP,179287-8,CDM,250,RC,,,68084011901,NDC,,,BOTH,,,2.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUDROCORTISONE,179921-2,CDM,250,RC,,,68084028801,NDC,,,BOTH,,,2.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPROPION 100MG,70695-2,CDM,250,RC,,,68001030900,NDC,,,BOTH,,,2.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIFEDIPINE 10MG,71283-6,CDM,250,RC,,,69315021101,NDC,,,BOTH,,,2.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORHEXIDINE 0.12%,171801-4,CDM,250,RC,,,69339013815,NDC,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYPROHEPTADINE 4MG,71237-2,CDM,250,RC,,,70710111001,NDC,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINASTERIDE 5MG,71837-9,CDM,250,RC,,,60687042801,NDC,,,BOTH,,,2.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOSORBIDE DN 10MG,70843-8,CDM,250,RC,,,68001037400,NDC,,,BOTH,,,2.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE VIS 2%15ML,172228-9,CDM,250,RC,,,50383077517,NDC,,,BOTH,,,2.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL 5MG,171864-2,CDM,250,RC,,,60687016101,NDC,,,BOTH,,,2.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERILE WATER 10ML-H,172646-2,CDM,250,RC,,,409488710,NDC,,,BOTH,,,2.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAZODONE 50MG-TEVA,179225-8,CDM,250,RC,,,50111056001,NDC,,,BOTH,,,2.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPRAZOLAM 1MG,71731-4,CDM,250,RC,,,51991070601,NDC,,,BOTH,,,2.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTULOSE 10GM-15ML,179395-9,CDM,250,RC,,,121087316,NDC,,,BOTH,,,2.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYUREA 500MG,172311-3,CDM,250,RC,,,68084028401,NDC,,,BOTH,,,2.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROID 60MG,171982-2,CDM,250,RC,,,456045901,NDC,,,BOTH,,,2.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMEPRAZOLE 20MG CAP,171792-5,CDM,250,RC,,,68084012801,NDC,,,BOTH,,,2.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL ER 25MG,72853-5,CDM,250,RC,,,60687039001,NDC,,,BOTH,,,2.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL ER 50MG,71927-8,CDM,250,RC,,,60687040211,NDC,,,BOTH,,,2.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBAMAZEPINE 200MG,71516-9,CDM,250,RC,,,904617261,NDC,,,BOTH,,,2.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOSINE 6MG/2ML-AK,179208-4,CDM,250,RC,,,17478054225,NDC,,,BOTH,,,2.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMIN 650MG SUPP,70003-9,CDM,250,RC,,,45802073030,NDC,,,BOTH,,,2.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCLOBENZAPRINE 10MG,179212-6,CDM,250,RC,,,93342201,NDC,,,BOTH,,,2.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENOXY-ATR 2.5MG,172607-4,CDM,250,RC,,,60687056901,NDC,,,BOTH,,,2.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FERREX 150MG FORTE,179421-3,CDM,250,RC,,,51991079890,NDC,,,BOTH,,,2.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARGINAID PACKET 9.2G,179840-4,CDM,250,RC,,,43900035988,NDC,,,BOTH,,,2.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARGINAID-ORANGE-NEST,179178-9,CDM,250,RC,,,43900035980,NDC,,,BOTH,,,2.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIOTHIXENE 1MG,71131-7,CDM,250,RC,,,378100101,NDC,,,BOTH,,,2.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METFORMIN 850MG,72561-4,CDM,250,RC,,,70010006401,NDC,,,BOTH,,,2.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFATRIM PE200-40MP,172669-4,CDM,250,RC,,,121085416,NDC,,,BOTH,,,2.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASONE 4MG PO,719095-2,CDM,250,RC,,,54817525,NDC,,,BOTH,,,2.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE/AP10/325,72478-1,CDM,250,RC,,,406012562,NDC,,,BOTH,,,2.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN 400MG,72178-7,CDM,250,RC,,,60687060201,NDC,,,BOTH,,,2.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIMEPIRIDE 4MG,72135-7,CDM,250,RC,,,68084032701,NDC,,,BOTH,,,2.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHL FLUSH STERIL,171784-2,CDM,250,RC,,,8290306553,NDC,,,BOTH,,,2.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROSTAT CHERRY 15GM,179275-3,CDM,250,RC,,,26974041017,NDC,,,BOTH,,,2.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIZANIDINE 2MG TAB,179367-8,CDM,250,RC,,,55111017915,NDC,,,BOTH,,,2.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRO STAT 30ML,172274-3,CDM,250,RC,,,26974041042,NDC,,,BOTH,,,2.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POVIDONE/IODINE SOL,179180-5,CDM,250,RC,,,904110309,NDC,,,BOTH,,,2.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE 50MG,719132-3,CDM,250,RC,,,641037625,NDC,,,BOTH,,,2.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE 50MG,175-0,CDM,250,RC,,,641037625,NDC,,,BOTH,,,2.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE 50MG,359-0,CDM,250,RC,,,641037625,NDC,,,BOTH,,,2.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBERSOURCE 250ML,172422-8,CDM,250,RC,,,43900018555,NDC,,,BOTH,,,2.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISONIAZID 300MG,70857-8,CDM,250,RC,,,51079008320,NDC,,,BOTH,,,3.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUMETANIDE 1MG TAB,170191-1,CDM,250,RC,,,60687038401,NDC,,,BOTH,,,3.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISACODYL 10MG SUPP,70437-9,CDM,250,RC,,,574705050,NDC,,,BOTH,,,3.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCOPYRROLATE 1MG,172012-7,CDM,250,RC,,,13107001401,NDC,,,BOTH,,,3.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VISIPAQUE 320MG/ML,172493-9,CDM,250,RC,,,407222317,NDC,,,BOTH,,,3.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPROPION 75MG,70139-1,CDM,250,RC,,,60687034001,NDC,,,BOTH,,,3.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STER WATER 1000ML,719020-0,CDM,250,RC,,,338000404,NDC,,,BOTH,,,3.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISONIAZID 300MG TAB,179489-0,CDM,250,RC,,,60687055301,NDC,,,BOTH,,,3.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINOCYCLINE 100MG C,179524-4,CDM,250,RC,,,60687033665,NDC,,,BOTH,,,3.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NABUMETONE 500MG,71825-4,CDM,250,RC,,,69097096507,NDC,,,BOTH,,,3.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN300MGAMNEA,179173-0,CDM,250,RC,,,65162010210,NDC,,,BOTH,,,3.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEOPHYLLINE ER 400M,172348-5,CDM,250,RC,,,68462038001,NDC,,,BOTH,,,3.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIPIZIDE XL 2.5MG,179797-6,CDM,250,RC,,,68084029521,NDC,,,BOTH,,,3.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTERIOSTAT 0.9%10M,172157-0,CDM,250,RC,,,409196612,NDC,,,BOTH,,,3.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEGESTROL 40 MG,70221-7,CDM,250,RC,,,904357161,NDC,,,BOTH,,,3.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN 300MG,72215-7,CDM,250,RC,,,60687059101,NDC,,,BOTH,,,3.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISOPROLOL 10MG,72473-2,CDM,250,RC,,,29300012613,NDC,,,BOTH,,,3.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DICLOFENAC 25MG,71706-6,CDM,250,RC,,,68001027900,NDC,,,BOTH,,,3.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIVALPROEX 125MG,172116-6,CDM,250,RC,,,68084031301,NDC,,,BOTH,,,3.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISOPROLOL 5MG TAB,72281-9,CDM,250,RC,,,50268012715,NDC,,,BOTH,,,3.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERAPAMIL 180MG SR,71645-6,CDM,250,RC,,,60687050401,NDC,,,BOTH,,,3.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOPERAMIDE 2MG-PREC,172605-8,CDM,250,RC,,,68094012962,NDC,,,BOTH,,,3.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETODOLAC 400MG,179159-9,CDM,250,RC,,,69238134201,NDC,,,BOTH,,,3.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PYRIDOSTIGMINE 60MG,179337-1,CDM,250,RC,,,60687050201,NDC,,,BOTH,,,3.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLEET ENEMA-CHILD-GE,170683-7,CDM,250,RC,,,132020220,NDC,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENTOXIFYLLINE 400MG,71635-7,CDM,250,RC,,,904544861,NDC,,,BOTH,,,3.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FELODIPINE 5MG ER,71917-9,CDM,250,RC,,,13668013301,NDC,,,BOTH,,,3.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FELODIPINE5MGERRISIN,179141-7,CDM,250,RC,,,57237010901,NDC,,,BOTH,,,3.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JEVITY 1.2,172485-5,CDM,250,RC,,,70074064624,NDC,,,BOTH,,,3.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PILOCARPINE 5MG,172025-9,CDM,250,RC,,,228280111,NDC,,,BOTH,,,3.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NORMAL SALINE 20ML-H,179281-1,CDM,250,RC,,,409488803,NDC,,,BOTH,,,3.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENSURE VANILLA,72839-4,CDM,250,RC,,,70074058298,NDC,,,BOTH,,,3.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENALAPRIL 5MG,71687-8,CDM,250,RC,,,904550261,NDC,,,BOTH,,,3.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISOLONE15MG/5ML,172327-9,CDM,250,RC,,,60432021208,NDC,,,BOTH,,,3.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JEVITY 1.5,72840-2,CDM,250,RC,,,70074064626,NDC,,,BOTH,,,3.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TWO CAL HN,72843-6,CDM,250,RC,,,70074064807,NDC,,,BOTH,,,3.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBIDOPA/LEODOPA CR,179162-3,CDM,250,RC,,,68084028201,NDC,,,BOTH,,,3.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIQUACEL16GM 1OZ-GHP,179176-3,CDM,250,RC,,,82028010095,NDC,,,BOTH,,,3.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERAZOSIN 1MG,719064-8,CDM,250,RC,,,59746038306,NDC,,,BOTH,,,3.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERAZOSIN 5MG,72317-1,CDM,250,RC,,,50268076615,NDC,,,BOTH,,,3.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYRICA 100MG CAP,179420-5,CDM,250,RC,,,60687050601,NDC,,,BOTH,,,3.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOSORBIDE DINO 10MG,172613-2,CDM,250,RC,,,68084008201,NDC,,,BOTH,,,3.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGABALIN 25MG CAP,172551-4,CDM,250,RC,,,60687047301,NDC,,,BOTH,,,3.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGABALIN 75MG CAP,179549-1,CDM,250,RC,,,60687049501,NDC,,,BOTH,,,3.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGABLIN 50MG CAP,172563-9,CDM,250,RC,,,60687048401,NDC,,,BOTH,,,3.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENALAPRIL 10MG-MAJOR,71685-2,CDM,250,RC,,,904561061,NDC,,,BOTH,,,3.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETHAMBUTOL 400MG TAB,179340-5,CDM,250,RC,,,68084028101,NDC,,,BOTH,,,3.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOMYCIN 500 MG,71959-1,CDM,250,RC,,,39822031005,NDC,,,BOTH,,,3.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEGRETOL XR 100MG,72387-4,CDM,250,RC,,,78051005,NDC,,,BOTH,,,3.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPAFENONE 150MG,70590-5,CDM,250,RC,,,62559023001,NDC,,,BOTH,,,3.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYNTHROID 0.2 MG,71471-7,CDM,250,RC,,,74714811,NDC,,,BOTH,,,3.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYNTHROID 75MCG,72306-4,CDM,250,RC,,,74518211,NDC,,,BOTH,,,3.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERAPAMIL 240MG ER,70335-5,CDM,250,RC,,,68462026001,NDC,,,BOTH,,,3.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICONAZOLE 7 SUPP,179784-4,CDM,250,RC,,,472173607,NDC,,,BOTH,,,3.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTULOSE SOL 20GM,172679-3,CDM,250,RC,,,66689003850,NDC,,,BOTH,,,3.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOSORBIDE MN 30MG T,72312-2,CDM,250,RC,,,68084059101,NDC,,,BOTH,,,3.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM AUTATE 667MG,172574-6,CDM,250,RC,,,68084047901,NDC,,,BOTH,,,3.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGOXIN 125MCG,70928-7,CDM,250,RC,,,904592161,NDC,,,BOTH,,,3.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOOST CHOCOLATE PUD,179413-0,CDM,250,RC,,,41679094603,NDC,,,BOTH,,,3.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUTAL/APAP/CAFFEINE,71836-1,CDM,250,RC,,,527169501,NDC,,,BOTH,,,3.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAPTOPRIL 12.5MG,719019-2,CDM,250,RC,,,60687030421,NDC,,,BOTH,,,3.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINOXIDIL 2.5MG,71823-9,CDM,250,RC,,,68084020401,NDC,,,BOTH,,,3.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINOCYCLINE 50MG CAP,172346-9,CDM,250,RC,,,591569401,NDC,,,BOTH,,,3.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEINEX LIQ 30ML,729002-6,CDM,250,RC,,,54859051516,NDC,,,BOTH,,,4.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIVALPROEX DR 250MG,179873-5,CDM,250,RC,,,68084077601,NDC,,,BOTH,,,4.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBAMIDE H202 OTIC,172113-3,CDM,250,RC,,,904662735,NDC,,,BOTH,,,4.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACEBUTOLOL 200MG,71495-6,CDM,250,RC,,,50268005015,NDC,,,BOTH,,,4.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCINOLONE 0.1%80,179308-2,CDM,250,RC,,,45802066436,NDC,,,BOTH,,,4.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACT WATER 30ML-HOSP,179280-3,CDM,250,RC,,,409397701,NDC,,,BOTH,,,4.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIFEDIPINE 30MG SA,71345-3,CDM,250,RC,,,68084059701,NDC,,,BOTH,,,4.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOVOLOG MIX 70/30 5U,171877-4,CDM,250,RC,,,169368512,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 50MG CT-AH,172590-2,CDM,250,RC,,,60687015625,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHLORIDE23.4%,171995-4,CDM,250,RC,,,63323018730,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAZOSIN 1MG,179160-7,CDM,250,RC,,,51079063020,NDC,,,BOTH,,,4.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CILOSTAZOL 100MG,729003-4,CDM,250,RC,,,93206406,NDC,,,BOTH,,,4.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLY PATCH 0.1MG,71568-0,CDM,250,RC,,,378910293,NDC,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPHENIDATE 20MG,179440-3,CDM,250,RC,,,78044105,NDC,,,BOTH,,,4.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE 15MG ER,72356-9,CDM,250,RC,,,406839062,NDC,,,BOTH,,,4.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMOXIFEN 10MG,71177-0,CDM,250,RC,,,591247260,NDC,,,BOTH,,,4.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMOXIFEN 10MG-AUROB,179210-0,CDM,250,RC,,,59651029960,NDC,,,BOTH,,,4.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENOFIBRATE 48MG,172239-6,CDM,250,RC,,,378306577,NDC,,,BOTH,,,4.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIRALAX PWD PAC 17GR,172248-7,CDM,250,RC,,,60687043199,NDC,,,BOTH,,,4.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITRO PATCH 0.2MG/HR,179296-9,CDM,250,RC,,,378910493,NDC,,,BOTH,,,4.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPROPION SR 150MG,179117-7,CDM,250,RC,,,70436005901,NDC,,,BOTH,,,4.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARVEDILOL 6.25MG,179869-3,CDM,250,RC,,,68084085401,NDC,,,BOTH,,,4.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZONISAMIDE 100MG CAP,172406-1,CDM,250,RC,,,51079076820,NDC,,,BOTH,,,4.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACYCLOVIR 400MG TAB,172048-1,CDM,250,RC,,,68084010801,NDC,,,BOTH,,,4.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RIFAMPIN 150MG,179683-8,CDM,250,RC,,,60687057521,NDC,,,BOTH,,,4.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETAMINE100MG/1 5ML,179444-5,CDM,250,RC,,,409205105,NDC,,,BOTH,,,4.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXEPIN 100MG CAP,172463-2,CDM,250,RC,,,51079065120,NDC,,,BOTH,,,4.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENLAFAXINE 37.5MG,172124-0,CDM,250,RC,,,68084033001,NDC,,,BOTH,,,4.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLECAINIDE 50MG TAB,172486-3,CDM,250,RC,,,54001020,NDC,,,BOTH,,,4.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZIDOVUDINE 100MG,71874-2,CDM,250,RC,,,65862010701,NDC,,,BOTH,,,4.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOSORBIDE MN 60MG T,71929-4,CDM,250,RC,,,68084059201,NDC,,,BOTH,,,4.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENLAFAXINE 50MG,172125-7,CDM,250,RC,,,68001015900,NDC,,,BOTH,,,4.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NATEGLINIDE 120MG,179886-7,CDM,250,RC,,,68084045921,NDC,,,BOTH,,,4.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOLAZONE 2.5MG TAB,172214-9,CDM,250,RC,,,185505001,NDC,,,BOTH,,,4.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUSPIRONE 15MG TAB,179333-0,CDM,250,RC,,,51079096020,NDC,,,BOTH,,,4.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLEET MINERAL OIL,70683-8,CDM,250,RC,,,132030140,NDC,,,BOTH,,,4.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBUPROFEN 100/5-PD,179203-5,CDM,250,RC,,,68094003701,NDC,,,BOTH,,,4.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHENAMINE 1GM TAB,172408-7,CDM,250,RC,,,65862078201,NDC,,,BOTH,,,4.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHENAMINE HIPP 1GR,172632-2,CDM,250,RC,,,50742014201,NDC,,,BOTH,,,4.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARVEDILOL 3.125MG-P,172497-0,CDM,250,RC,,,904630061,NDC,,,BOTH,,,4.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARVEDILOL 6.25MG  M,172575-3,CDM,250,RC,,,904630161,NDC,,,BOTH,,,4.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCOPYRROLATE 2MG,179836-2,CDM,250,RC,,,49884006601,NDC,,,BOTH,,,4.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROGESTERONE 100MG,72549-9,CDM,250,RC,,,17478076610,NDC,,,BOTH,,,4.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALINE NASAL SPRAY,70598-8,CDM,250,RC,,,904386575,NDC,,,BOTH,,,4.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERPHENAZINE 4MG,172415-2,CDM,250,RC,,,68084060201,NDC,,,BOTH,,,4.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERPHENAZINE 4MG TAB,179319-9,CDM,250,RC,,,68084060201,NDC,,,BOTH,,,4.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINOXIDIL 10MG,72164-7,CDM,250,RC,,,68084020501,NDC,,,BOTH,,,4.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACET 650/20.3ML-AHP,179235-7,CDM,250,RC,,,60687057137,NDC,,,BOTH,,,4.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICOTINE 21MG,179945-1,CDM,250,RC,,,68001043490,NDC,,,BOTH,,,5.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICOTINE 7MG,179946-9,CDM,250,RC,,,68001043290,NDC,,,BOTH,,,5.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHERRY SYRUP 473ML,179457-7,CDM,250,RC,,,31722093847,NDC,,,BOTH,,,5.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDAZOLAM 2MG LIQ,72367-6,CDM,250,RC,,,54356699,NDC,,,BOTH,,,5.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALPROIC ACID 250MG,172325-3,CDM,250,RC,,,121467505,NDC,,,BOTH,,,5.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSLYRA 667MG/5ML-F,179270-4,CDM,250,RC,,,49230064331,NDC,,,BOTH,,,5.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANALGESIC BALM 1OZ,179435-3,CDM,250,RC,,,57896011601,NDC,,,BOTH,,,5.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITRO/TRANSD 0.4MG,72851-9,CDM,250,RC,,,68382031030,NDC,,,BOTH,,,5.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENSURE PLUS 8OZ,171886-5,CDM,250,RC,,,70074058304,NDC,,,BOTH,,,5.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICARDIPINE 20MG CAP,179819-8,CDM,250,RC,,,378102077,NDC,,,BOTH,,,5.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMETH DROPS30-RUGBY,179118-5,CDM,250,RC,,,536130375,NDC,,,BOTH,,,5.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACROLIMUS 0.5MG,172419-4,CDM,250,RC,,,68084044901,NDC,,,BOTH,,,5.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IODINE DOUCHE 4.5OZ,179390-0,CDM,250,RC,,,132874302,NDC,,,BOTH,,,5.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUMMER'S EVE DOUCHE,179427-0,CDM,250,RC,,,132874302,NDC,,,BOTH,,,5.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOLAZONE 2.5MG TAB,179263-9,CDM,250,RC,,,76838501360,NDC,,,BOTH,,,5.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPYRIDAMOLE 25MG,172364-2,CDM,250,RC,,,64980013401,NDC,,,BOTH,,,5.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORTHALIDONE 25MG,70776-0,CDM,250,RC,,,51079005820,NDC,,,BOTH,,,5.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GEMFIBROZIL 600MG,70479-1,CDM,250,RC,,,60687022401,NDC,,,BOTH,,,5.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOTALOL 80MG TAB,719131-5,CDM,250,RC,,,68084065401,NDC,,,BOTH,,,5.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXAZEPAM 10MG,71412-1,CDM,250,RC,,,62584081201,NDC,,,BOTH,,,5.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MILK OG MAGNESIA 30M,172662-9,CDM,250,RC,,,60687042976,NDC,,,BOTH,,,5.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCRETS BOX OF 18,71500-3,CDM,250,RC,,,36373600885,NDC,,,BOTH,,,5.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELECOXIB 200MG CAP,179389-2,CDM,250,RC,,,60687047701,NDC,,,BOTH,,,5.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMIN 650/20,72803-0,CDM,250,RC,,,121197121,NDC,,,BOTH,,,5.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIVALPROEX ER 250MG,172115-8,CDM,250,RC,,,68084031001,NDC,,,BOTH,,,5.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG/5ML,179826-3,CDM,250,RC,,,68094075662,NDC,,,BOTH,,,5.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CETIRIZINE 10MG,172345-1,CDM,250,RC,,,51079059701,NDC,,,BOTH,,,5.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CETIRIZINE 10MG TAB,172576-1,CDM,250,RC,,,68001043696,NDC,,,BOTH,,,5.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENTAZOCINE/NALO50MG,71508-6,CDM,250,RC,,,591039501,NDC,,,BOTH,,,5.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUAIFENESIN DM S 5ML,172251-1,CDM,250,RC,,,121063805,NDC,,,BOTH,,,5.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROPINIROL2MG-ALEMBIC,179189-6,CDM,250,RC,,,62332003331,NDC,,,BOTH,,,5.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROPINIROLE 4MG TAB,172242-0,CDM,250,RC,,,62332003531,NDC,,,BOTH,,,5.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENASEPTIC SPRAY,179899-0,CDM,250,RC,,,409630521,NDC,,,BOTH,,,5.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROPINIROLE 0.5MG TAB,172275-0,CDM,250,RC,,,62332003131,NDC,,,BOTH,,,5.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAZOSIN 2MG,172220-6,CDM,250,RC,,,51079063120,NDC,,,BOTH,,,5.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOPIRAMATE 25MG,172374-1,CDM,250,RC,,,68382013814,NDC,,,BOTH,,,5.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATROVENT HFA 17MCG I,719125-7,CDM,250,RC,,,597008717,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENSURE CLEAR LIQUID,179372-8,CDM,250,RC,,,70074062481,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUVOXAMINE 50MG,71940-1,CDM,250,RC,,,62559015901,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEXILETINE 150MG CAP,179552-5,CDM,250,RC,,,60687077811,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MULTIVIT/MINERAL15ML,179393-4,CDM,250,RC,,,81033050150,NDC,,,BOTH,,,6.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CH 0.9%-100ML,172656-1,CDM,250,RC,,,338004938,NDC,,,BOTH,,,6.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOPAMINE 400 MG,71885-8,CDM,250,RC,,,409910420,NDC,,,BOTH,,,6.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE 10MG-BLP,172617-3,CDM,250,RC,,,68001039900,NDC,,,BOTH,,,6.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXCARBAZEPINE 300MG,179295-1,CDM,250,RC,,,68462013801,NDC,,,BOTH,,,6.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENSURE ENLIVE VANILL,172462-4,CDM,250,RC,,,70074064290,NDC,,,BOTH,,,6.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXAZEPAM 15MG,71413-9,CDM,250,RC,,,62584081301,NDC,,,BOTH,,,6.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOXICILLIN 250MG,70109-4,CDM,250,RC,,,60687077601,NDC,,,BOTH,,,6.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOVENT HFA 110MCGIN,72017-7,CDM,250,RC,,,173071920,NDC,,,BOTH,,,6.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN A/D OINT 1.5,179108-6,CDM,250,RC,,,41100081122,NDC,,,BOTH,,,6.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYOSCYAMINE DR 0.125,179731-5,CDM,250,RC,,,54838050615,NDC,,,BOTH,,,6.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OCTREOTIDE 0.05MG/ML,172527-4,CDM,250,RC,,,703330104,NDC,,,BOTH,,,6.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENAZOPYRIDINE100MG,71302-4,CDM,250,RC,,,69367016204,NDC,,,BOTH,,,6.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDODRINE 5MG TAB-MY,172645-4,CDM,250,RC,,,51079045320,NDC,,,BOTH,,,6.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIRTAZAPINE 15MG,72066-4,CDM,250,RC,,,51079008601,NDC,,,BOTH,,,6.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLECAINIDE 100MG TAB,179535-0,CDM,250,RC,,,62559038101,NDC,,,BOTH,,,6.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSELTAMIVIR PHOS 6MG,172488-9,CDM,250,RC,,,70710116506,NDC,,,BOTH,,,6.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALCOHOL 70%,72875-8,CDM,250,RC,,,869081043,NDC,,,BOTH,,,6.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METRONIDAZOLE 500MG,172599-3,CDM,250,RC,,,25021013182,NDC,,,BOTH,,,6.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METRONIDAZOLE 500MGP,70608-5,CDM,250,RC,,,338105548,NDC,,,BOTH,,,6.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOLNAFTATE 1% CR15GM,179719-0,CDM,250,RC,,,904072236,NDC,,,BOTH,,,6.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROL OINT U/D,71178-8,CDM,250,RC,,,281032608,NDC,,,BOTH,,,6.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXCARBAZEPINE 300MG,172297-4,CDM,250,RC,,,68084085301,NDC,,,BOTH,,,6.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POT CITRATE,171846-9,CDM,250,RC,,,245007111,NDC,,,BOTH,,,6.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORAJEL MED 0.25OZ,172699-1,CDM,250,RC,,,10310022240,NDC,,,BOTH,,,6.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHL 0.9%-100M,172655-3,CDM,250,RC,,,338004948,NDC,,,BOTH,,,6.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAROXETINE20MG-AHP,179143-3,CDM,250,RC,,,68084004511,NDC,,,BOTH,,,6.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAROXETINE 10MG,729013-3,CDM,250,RC,,,904567661,NDC,,,BOTH,,,6.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JUVEN POWDER PACKET,179379-3,CDM,250,RC,,,59781066678,NDC,,,BOTH,,,6.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EYE WASH 4OZ,179922-0,CDM,250,RC,,,10119000252,NDC,,,BOTH,,,6.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGOXIN 0.05MG/ML 5M,171847-7,CDM,250,RC,,,54005746,NDC,,,BOTH,,,6.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHEN 25MG/10ML,179284-5,CDM,250,RC,,,69339015201,NDC,,,BOTH,,,6.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IRBESARTAN 75MG TAB,172506-8,CDM,250,RC,,,33342004710,NDC,,,BOTH,,,6.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAROXETINE 20MG,71845-2,CDM,250,RC,,,904567761,NDC,,,BOTH,,,6.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUPLENA 8OZ,719035-8,CDM,250,RC,,,70074064793,NDC,,,BOTH,,,6.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAMIPEXOLE 1.5MG TA,179542-6,CDM,250,RC,,,13668009590,NDC,,,BOTH,,,6.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS 50ML,179663-0,CDM,250,RC,,,990798413,NDC,,,BOTH,,,6.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAMIPEXOLE 0.125MG,179952-7,CDM,250,RC,,,13668009190,NDC,,,BOTH,,,6.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAMIPEXOLE 1MG,179953-5,CDM,250,RC,,,13668009490,NDC,,,BOTH,,,6.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFANTS GAS REL DROP,179110-2,CDM,250,RC,,,69618005951,NDC,,,BOTH,,,6.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
L-METHYLFOLATE 15MG,179423-9,CDM,250,RC,,,70954056010,NDC,,,BOTH,,,6.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE LIQD,179285-2,CDM,250,RC,,,69339015105,NDC,,,BOTH,,,7.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVETIRACETAN O 500M,172608-2,CDM,250,RC,,,121479940,NDC,,,BOTH,,,7.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS 100ML ADDVANTAGE,719061-4,CDM,250,RC,,,409710167,NDC,,,BOTH,,,7.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TORSEMIDE 100MG,179720-8,CDM,250,RC,,,31722053201,NDC,,,BOTH,,,7.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICONAZOLE 2.0% PWDR,179562-4,CDM,250,RC,,,53329016979,NDC,,,BOTH,,,7.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IRBESARTAN 150MG,172068-9,CDM,250,RC,,,955104190,NDC,,,BOTH,,,7.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IRBESARTAN 150MG T-H,172681-9,CDM,250,RC,,,42658012204,NDC,,,BOTH,,,7.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALPROIC ACSYR500/10,179338-9,CDM,250,RC,,,121135000,NDC,,,BOTH,,,7.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPHONE 4MG/ML,179696-0,CDM,250,RC,,,409130431,NDC,,,BOTH,,,7.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEALTH SHAKE CHOCOLA,719082-0,CDM,250,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEALTH SHAKE STRAWBY,719083-8,CDM,250,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEALTH SHAKE VANILLA,719084-6,CDM,250,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IRBESARTAN150MG-CAMB,179194-6,CDM,250,RC,,,31722073090,NDC,,,BOTH,,,7.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VASOLINE 368 GM,172357-6,CDM,250,RC,,,904573182,NDC,,,BOTH,,,7.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCERNA 1.5 CALORIE,179907-1,CDM,250,RC,,,70074064919,NDC,,,BOTH,,,7.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORT 1% CR 454G,179307-4,CDM,250,RC,,,45802043805,NDC,,,BOTH,,,7.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICARDIPINE 30MG,72454-2,CDM,250,RC,,,378143077,NDC,,,BOTH,,,7.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCOD/CH/R10-8/5M,71589-6,CDM,250,RC,,,27808008602,NDC,,,BOTH,,,7.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSPORIN OINT 30GM,71151-5,CDM,250,RC,,,904073431,NDC,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEGRETOL XR 200MG,179698-6,CDM,250,RC,,,78051105,NDC,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICONAZOLE NITRATE2%,179787-7,CDM,250,RC,,,472073556,NDC,,,BOTH,,,7.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOX/CLAVULANATE 600,179470-0,CDM,250,RC,,,781613954,NDC,,,BOTH,,,7.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOLESTYRAMINE 4GM,72513-5,CDM,250,RC,,,68382052860,NDC,,,BOTH,,,7.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOLESTYRAMINEPKTPAR,179204-3,CDM,250,RC,,,49884046564,NDC,,,BOTH,,,7.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMORRHOIDAL OINT,172272-7,CDM,250,RC,,,46122067746,NDC,,,BOTH,,,7.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIODARONE 200MG-AUR,179224-1,CDM,250,RC,,,65862073260,NDC,,,BOTH,,,7.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOLTERODINE 2MG,172119-0,CDM,250,RC,,,33342009809,NDC,,,BOTH,,,7.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOLTERODINE 2MG-TEVA,179244-9,CDM,250,RC,,,93001806,NDC,,,BOTH,,,7.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEX 5%/WATER 250CC-B,172585-2,CDM,250,RC,,,264751020,NDC,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMANTADINE 100MG TAB,172514-2,CDM,250,RC,,,50268006915,NDC,,,BOTH,,,8.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUSCLE RUB 3OZ,172571-2,CDM,250,RC,,,45802017453,NDC,,,BOTH,,,8.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMETHICONE DROPS30M,179942-8,CDM,250,RC,,,904589430,NDC,,,BOTH,,,8.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVETIRACETAM 500MG,179944-4,CDM,250,RC,,,51079082101,NDC,,,BOTH,,,8.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPRO,179883-4,CDM,250,RC,,,70074064799,NDC,,,BOTH,,,8.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROFURANTOIN 100MG,172192-7,CDM,250,RC,,,68084044601,NDC,,,BOTH,,,8.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPHENHYDRAMINE LIQ,70160-7,CDM,250,RC,,,121048905,NDC,,,BOTH,,,8.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERIDONE 0.25MG,172503-5,CDM,250,RC,,,904605761,NDC,,,BOTH,,,8.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALAMINE LOTION,71903-9,CDM,250,RC,,,24385041396,NDC,,,BOTH,,,8.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPIVACAINE 0.5%,72090-4,CDM,250,RC,,,55150016910,NDC,,,BOTH,,,8.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIOTHIXEN E 5MG,71192-9,CDM,250,RC,,,51079058820,NDC,,,BOTH,,,8.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALINE FLUSH 10CC,719117-4,CDM,250,RC,,,64253011130,NDC,,,BOTH,,,8.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D10 WATER/M CC-BRAUN,172578-7,CDM,250,RC,,,264752000,NDC,,,BOTH,,,8.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICOTINE 14MG,179947-7,CDM,250,RC,,,135019502,NDC,,,BOTH,,,8.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROBENECID 500MG TAB,172370-9,CDM,250,RC,,,527136701,NDC,,,BOTH,,,8.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENLAFAXINE ER 37.5M,172123-2,CDM,250,RC,,,68084033001,NDC,,,BOTH,,,8.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENADRYL CR 30 GM,70159-9,CDM,250,RC,,,501320001,NDC,,,BOTH,,,8.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSYNEPHRINE 0.25%,71147-3,CDM,250,RC,,,225080047,NDC,,,BOTH,,,8.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSYNEPHRINE 0.5%,71160-6,CDM,250,RC,,,225080547,NDC,,,BOTH,,,8.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTHRITIS HAT CR 3OZ,172691-8,CDM,250,RC,,,41167060002,NDC,,,BOTH,,,9.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUTOSE GEL,72007-8,CDM,250,RC,,,574006930,NDC,,,BOTH,,,9.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHLORIDE 500M,172403-8,CDM,250,RC,,,338004903,NDC,,,BOTH,,,9.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS 250 ADDVANTAGE,179893-3,CDM,250,RC,,,409710102,NDC,,,BOTH,,,9.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 1%,70783-6,CDM,250,RC,,,45802043803,NDC,,,BOTH,,,9.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYMETAZOLINE 0.05%,70017-9,CDM,250,RC,,,45802041059,NDC,,,BOTH,,,9.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL 10MEQ,179255-5,CDM,250,RC,,,50268067113,NDC,,,BOTH,,,9.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NADOLOL 40MG,70298-5,CDM,250,RC,,,68001031800,NDC,,,BOTH,,,9.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERILE WATER INJ5ML,179570-7,CDM,250,RC,,,63323018505,NDC,,,BOTH,,,9.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALL LOZ HONEYLEMON,179320-7,CDM,250,RC,,,12546062213,NDC,,,BOTH,,,9.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMEGA 3 ACID EST 1GM,172390-7,CDM,250,RC,,,60687084665,NDC,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEOSOL ELIXIR 5CC,70603-6,CDM,250,RC,,,121053005,NDC,,,BOTH,,,9.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFUROXIME AXET 250M,179914-7,CDM,250,RC,,,60687027294,NDC,,,BOTH,,,9.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETYLCYSTEINE 20%,172651-2,CDM,250,RC,,,63323069030,NDC,,,BOTH,,,9.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAZOLAMIDE 250MG,172546-4,CDM,250,RC,,,68084054101,NDC,,,BOTH,,,9.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EYE DROP VISINE-GENE,172442-6,CDM,250,RC,,,24385007505,NDC,,,BOTH,,,9.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN/SULB 1.5G,719120-8,CDM,250,RC,,,641611610,NDC,,,BOTH,,,9.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMSULOSIN 0.4MG,179951-9,CDM,250,RC,,,904640161,NDC,,,BOTH,,,9.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMSULOSIN HCL 0.4MG,172674-4,CDM,250,RC,,,68084029901,NDC,,,BOTH,,,9.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIACIN ER 500MG,72775-0,CDM,250,RC,,,47335053981,NDC,,,BOTH,,,9.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN A/D OINT 4-B,179107-8,CDM,250,RC,,,41100081124,NDC,,,BOTH,,,9.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFDINIR 125MG/5ML,171838-6,CDM,250,RC,,,93413664,NDC,,,BOTH,,,9.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NALTREXONE 50MG TAB,179699-4,CDM,250,RC,,,47335032683,NDC,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEGESTROL LIQUID,179684-6,CDM,250,RC,,,121477610,NDC,,,BOTH,,,10.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEOPHYLLINE 300MG,172380-8,CDM,250,RC,,,62332002531,NDC,,,BOTH,,,10.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOX/CLAV 250/5 5ML,70135-9,CDM,250,RC,,,60432006575,NDC,,,BOTH,,,10.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URENA UREA POWDER,179536-8,CDM,250,RC,,,62530000011,NDC,,,BOTH,,,10.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYCHLORO 200MG,71860-1,CDM,250,RC,,,68084026901,NDC,,,BOTH,,,10.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACROLIMUS 1MG CAP,172383-2,CDM,250,RC,,,68084045001,NDC,,,BOTH,,,10.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WELCHOL 625MG,719085-3,CDM,250,RC,,,65597070118,NDC,,,BOTH,,,10.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOVASOURCE RENAL 8OZ,179548-3,CDM,250,RC,,,43900030609,NDC,,,BOTH,,,10.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBAMAZEPINE 200/10,172079-6,CDM,250,RC,,,68094021462,NDC,,,BOTH,,,10.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERIDONE 1MG,172276-8,CDM,250,RC,,,904635961,NDC,,,BOTH,,,10.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI-DANDRUFF SH 1%,172696-7,CDM,250,RC,,,536199553,NDC,,,BOTH,,,10.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMEPRAZOLE DR 20MG-G,172660-3,CDM,250,RC,,,68462039601,NDC,,,BOTH,,,10.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELEBREX 100MG CAP,179448-6,CDM,250,RC,,,72241002305,NDC,,,BOTH,,,10.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELECOXIB 100MG CAP,179439-5,CDM,250,RC,,,60687043601,NDC,,,BOTH,,,10.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTROGRAFIN 5ML,172440-0,CDM,250,RC,,,270044535,NDC,,,BOTH,,,10.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORT POWDER 1GM,179322-3,CDM,250,RC,,,574042010,NDC,,,BOTH,,,10.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RIVASTIGMINE 1.5MG C,179560-8,CDM,250,RC,,,62332006360,NDC,,,BOTH,,,10.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMERICAINE SPRAY,70037-7,CDM,250,RC,,,63736037802,NDC,,,BOTH,,,10.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLORAZEPATE 15MG,72372-6,CDM,250,RC,,,378007001,NDC,,,BOTH,,,10.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 20MEQ KCL1000ML-B,172579-5,CDM,250,RC,,,264762500,NDC,,,BOTH,,,10.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEO-24 200MG,172378-2,CDM,250,RC,,,52244020010,NDC,,,BOTH,,,11.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCO/APA5/217SO0L,179445-2,CDM,250,RC,,,66689000550,NDC,,,BOTH,,,11.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEBIVOLOL 5MG TAB,179928-7,CDM,250,RC,,,43547052503,NDC,,,BOTH,,,11.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MELOXICAM 15MG,179939-4,CDM,250,RC,,,60687019911,NDC,,,BOTH,,,11.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 2.5 %C,70065-8,CDM,250,RC,,,45802000402,NDC,,,BOTH,,,11.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALPROTECT 4OZ RELIA,179260-5,CDM,250,RC,,,69618006782,NDC,,,BOTH,,,11.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCO/AP 7.5/15ML,179816-4,CDM,250,RC,,,60687041771,NDC,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMVASTATIN 20MG TAB,179471-8,CDM,250,RC,,,68180047901,NDC,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUBRIFRESH PM,172231-3,CDM,250,RC,,,904516838,NDC,,,BOTH,,,11.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IVERMECTIN 3MG TAB,172530-8,CDM,250,RC,,,42799080601,NDC,,,BOTH,,,11.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREON 12000 DR CAP,179476-7,CDM,250,RC,,,32004770,NDC,,,BOTH,,,11.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN A/D OINT 4OZ,179109-4,CDM,250,RC,,,24385007026,NDC,,,BOTH,,,11.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIOTHIXENE 10MG,71195-2,CDM,250,RC,,,51079058920,NDC,,,BOTH,,,11.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPER/TAZ 2.25G-HOSP,179135-9,CDM,250,RC,,,409337402,NDC,,,BOTH,,,11.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHL IR 1000MLBAG,172532-4,CDM,250,RC,,,990797205,NDC,,,BOTH,,,12.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANEXAMIC 650MG TAB,179392-6,CDM,250,RC,,,591372030,NDC,,,BOTH,,,12.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTISEP SKIN 4%-GNP,179134-2,CDM,250,RC,,,46122013734,NDC,,,BOTH,,,12.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYLICON DROPS,179369-4,CDM,250,RC,,,62372063015,NDC,,,BOTH,,,12.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUININE SULFATE 324M,172361-8,CDM,250,RC,,,68084094732,NDC,,,BOTH,,,12.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTINE MAX PAIN SPY,172504-3,CDM,250,RC,,,16500050827,NDC,,,BOTH,,,12.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXYCYCLINE 100MG,71673-8,CDM,250,RC,,,62584069321,NDC,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXYCYCLINE 100MG-AV,172592-8,CDM,250,RC,,,50268027915,NDC,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENOBARBITAL/ELIXIR,71257-0,CDM,250,RC,,,60687044867,NDC,,,BOTH,,,12.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CIPROFLOXACIN 500MG,179252-2,CDM,250,RC,,,143992801,NDC,,,BOTH,,,12.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOMYCIN/BAC/POL3.5G,179923-8,CDM,250,RC,,,24208078055,NDC,,,BOTH,,,12.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERBUTALINE 2.5MG,70181-3,CDM,250,RC,,,115261101,NDC,,,BOTH,,,12.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AYR NASAL SALINE GEL,179387-6,CDM,250,RC,,,225052848,NDC,,,BOTH,,,12.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BIOTENE D MOUTH RINS,172023-4,CDM,250,RC,,,48582000330,NDC,,,BOTH,,,12.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCONTIN 10MG,72384-1,CDM,250,RC,,,59011041020,NDC,,,BOTH,,,12.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCONTIN 20MG,72286-8,CDM,250,RC,,,59011041020,NDC,,,BOTH,,,12.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAPER RASH OINTMENT,70389-2,CDM,250,RC,,,501340104,NDC,,,BOTH,,,12.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EUCERIN CR 2OZ-BEIER,179137-5,CDM,250,RC,,,72140003868,NDC,,,BOTH,,,12.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTIAN VIOLET 1%-,172522-5,CDM,250,RC,,,24385000346,NDC,,,BOTH,,,12.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 0.5%C,179791-9,CDM,250,RC,,,51672201002,NDC,,,BOTH,,,12.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONTELUKAST SOD 10MG,172624-9,CDM,250,RC,,,68084087501,NDC,,,BOTH,,,12.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTIFICIAL TEARS-GER,179123-5,CDM,250,RC,,,57896018105,NDC,,,BOTH,,,12.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCINOLONE 0.1% O,171873-3,CDM,250,RC,,,45802005535,NDC,,,BOTH,,,13.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEDIALYTE,70491-6,CDM,250,RC,,,70074080365,NDC,,,BOTH,,,13.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONTELUKAST 4MG,172288-3,CDM,250,RC,,,31722072730,NDC,,,BOTH,,,13.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TET TOX FLUID 0.5/ML,71532-6,CDM,250,RC,,,49281082010,NDC,,,BOTH,,,13.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THERA GEL SHAMPOO B,179388-4,CDM,250,RC,,,904525944,NDC,,,BOTH,,,13.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENALAPRILAT 1.25MG/M,72822-0,CDM,250,RC,,,143978710,NDC,,,BOTH,,,13.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIPLE ANTIB ONT 30G,172682-7,CDM,250,RC,,,61269017956,NDC,,,BOTH,,,13.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VISINE DRY RELIEF 15,179306-6,CDM,250,RC,,,11726013801,NDC,,,BOTH,,,13.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 61% 5ML,172368-3,CDM,250,RC,,,270131547,NDC,,,BOTH,,,13.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOTRIMAZOLE 1% CR,179662-2,CDM,250,RC,,,45802043401,NDC,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCERIN LIQUID 5ML,179735-6,CDM,250,RC,,,87701040072,NDC,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METAXALONE 800MG TAB,179366-0,CDM,250,RC,,,68001000400,NDC,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLPIDEM T ER 12.5MG,172554-8,CDM,250,RC,,,68180078001,NDC,,,BOTH,,,14.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOPIRAMATE 100MG,172296-6,CDM,250,RC,,,68084034401,NDC,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPROPION XL 300MG,179446-0,CDM,250,RC,,,68001052005,NDC,,,BOTH,,,14.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETIC ACID 0.25%250,179303-3,CDM,250,RC,,,990614322,NDC,,,BOTH,,,14.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WATER/IRRIGATION 1L,179124-3,CDM,250,RC,,,990713909,NDC,,,BOTH,,,14.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BYSTOLIC 2OMG,172009-3,CDM,250,RC,,,456142030,NDC,,,BOTH,,,14.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAL LIO CAL LIQ,179558-2,CDM,250,RC,,,70074064829,NDC,,,BOTH,,,14.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORDIAZE/CLID5/2.5,179428-8,CDM,250,RC,,,60687063994,NDC,,,BOTH,,,15.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORAJEL,179673-9,CDM,250,RC,,,10310022213,NDC,,,BOTH,,,15.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUETIAPINE 100MG,172286-7,CDM,250,RC,,,60687034911,NDC,,,BOTH,,,15.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM ACETATE,172401-2,CDM,250,RC,,,51754200104,NDC,,,BOTH,,,15.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEGRETOL XR 400MG,72206-6,CDM,250,RC,,,78051205,NDC,,,BOTH,,,15.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 1/2 SALINEW/KCL20,72805-5,CDM,250,RC,,,338067104,NDC,,,BOTH,,,15.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC OXIDE 20%-1OZ-N,179292-8,CDM,250,RC,,,75834017001,NDC,,,BOTH,,,15.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC OXIDE 30GM,71982-3,CDM,250,RC,,,75834017001,NDC,,,BOTH,,,15.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGOXIN 500MCG/2ML I,179881-8,CDM,250,RC,,,641141035,NDC,,,BOTH,,,15.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE 20MG/5MLA,179197-9,CDM,250,RC,,,60687024467,NDC,,,BOTH,,,15.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUBIPROSTONE 24MCG-P,172598-5,CDM,250,RC,,,254302902,NDC,,,BOTH,,,15.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RANOLAZINE 500MG-AJA,172633-0,CDM,250,RC,,,27241012502,NDC,,,BOTH,,,15.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOX/CLAV 500/125 TA,719128-1,CDM,250,RC,,,781183101,NDC,,,BOTH,,,15.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOPIDOGREL 75MG TAB,172267-7,CDM,250,RC,,,68084053601,NDC,,,BOTH,,,15.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROPHOR OINT,171778-4,CDM,250,RC,,,536114397,NDC,,,BOTH,,,15.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE 20MG/5ML,172433-5,CDM,250,RC,,,121472105,NDC,,,BOTH,,,15.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVETIRACETAM 500/5M,172329-5,CDM,250,RC,,,60687024940,NDC,,,BOTH,,,16.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PYRAZINAMIDE 500MG T,179490-8,CDM,250,RC,,,,,,,BOTH,,,16.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEOPHYLLINE 100MG,179480-9,CDM,250,RC,,,27808003301,NDC,,,BOTH,,,16.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INF MOTRIN 50MG/1.25,392-1,CDM,250,RC,,,904546335,NDC,,,BOTH,,,16.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE O 20MG/5M,171962-4,CDM,250,RC,,,60687024471,NDC,,,BOTH,,,16.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACIT/POLY B OINT,71272-9,CDM,250,RC,,,69968006003,NDC,,,BOTH,,,16.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOSUVASTATIN 10MG,179561-6,CDM,250,RC,,,60687024501,NDC,,,BOTH,,,16.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACITRACIN,70151-6,CDM,250,RC,,,51672207502,NDC,,,BOTH,,,16.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAMIVUDINE 150MG,172132-3,CDM,250,RC,,,68180060207,NDC,,,BOTH,,,16.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JEVITY 1.5 RTH1000ML,171980-6,CDM,250,RC,,,70074062682,NDC,,,BOTH,,,16.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUCONAZOLE 200MG PM,719073-9,CDM,250,RC,,,69784000206,NDC,,,BOTH,,,16.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMEPRAZOLE 20MG,179874-3,CDM,250,RC,,,50268061911,NDC,,,BOTH,,,16.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALACYCLOVIR500MGCAM,179195-3,CDM,250,RC,,,31722070430,NDC,,,BOTH,,,16.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCRALFATE O PRE DOS,172619-9,CDM,250,RC,,,68094004359,NDC,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENTASA CR 500MG CAP,172553-0,CDM,250,RC,,,54092019112,NDC,,,BOTH,,,17.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREPARATION H OINT,71339-6,CDM,250,RC,,,573287193,NDC,,,BOTH,,,17.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUBRIDERM AT LOTION,171889-9,CDM,250,RC,,,52800048234,NDC,,,BOTH,,,17.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTIFICIAL TEARS,71599-5,CDM,250,RC,,,17478006012,NDC,,,BOTH,,,17.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMITIZA 24MCG CAP,179646-5,CDM,250,RC,,,64764024060,NDC,,,BOTH,,,17.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN 0.3MG,71273-7,CDM,250,RC,,,46110081,NDC,,,BOTH,,,17.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN 0.625MG,71274-5,CDM,250,RC,,,46110281,NDC,,,BOTH,,,17.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN 1.25MG,172349-3,CDM,250,RC,,,46110481,NDC,,,BOTH,,,17.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLY-OXIDE ORAL 0.5OZ,179258-9,CDM,250,RC,,,42037010475,NDC,,,BOTH,,,17.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM PHOSPATE,171996-2,CDM,250,RC,,,409729501,NDC,,,BOTH,,,17.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN 0.9MG,71270-3,CDM,250,RC,,,46110381,NDC,,,BOTH,,,17.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE JELLY 2%,179265-4,CDM,250,RC,,,25021067377,NDC,,,BOTH,,,17.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN 0.9MG-WYETH,179245-6,CDM,250,RC,,,46110381,NDC,,,BOTH,,,17.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE URO-JET,179788-5,CDM,250,RC,,,76329301305,NDC,,,BOTH,,,17.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DULOXETINE 30MG,172107-5,CDM,250,RC,,,68084068301,NDC,,,BOTH,,,18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOMYCIN/POLY B-20ML,179397-5,CDM,250,RC,,,39822122001,NDC,,,BOTH,,,18.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 250MG T,172692-6,CDM,250,RC,,,51224002230,NDC,,,BOTH,,,18.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSORCAINE 0.25%-30,179300-9,CDM,250,RC,,,63323046437,NDC,,,BOTH,,,18.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIAGABINE 4MG,172319-6,CDM,250,RC,,,62756022483,NDC,,,BOTH,,,18.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERCREME,71108-5,CDM,250,RC,,,41167057003,NDC,,,BOTH,,,18.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERCREME ORG CR,172693-4,CDM,250,RC,,,41167057003,NDC,,,BOTH,,,18.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOTRIMAZOLE CREAM,179381-9,CDM,250,RC,,,24385020503,NDC,,,BOTH,,,18.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALPROATE INJ 500MG,172259-4,CDM,250,RC,,,63323049405,NDC,,,BOTH,,,18.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALPROATE SOD 500/5,179377-7,CDM,250,RC,,,63323049401,NDC,,,BOTH,,,18.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENOFIBRATE 200MG C,172418-6,CDM,250,RC,,,68084032921,NDC,,,BOTH,,,18.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRILINTA 90MG,172234-7,CDM,250,RC,,,186077739,NDC,,,BOTH,,,18.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIX CREME RINSE 1%,172313-9,CDM,250,RC,,,63736002404,NDC,,,BOTH,,,18.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUMAZENIL 0.1MG/5ML,72820-4,CDM,250,RC,,,63323042405,NDC,,,BOTH,,,19.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DULOXETINE 20MG,172106-7,CDM,250,RC,,,68084067521,NDC,,,BOTH,,,19.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEO-24 400MG,172441-8,CDM,250,RC,,,52244040010,NDC,,,BOTH,,,19.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRILINTA TAB 90MG-A2,172621-5,CDM,250,RC,,,186077760,NDC,,,BOTH,,,19.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLOPATADINE 0.1% EYE,72079-7,CDM,250,RC,,,60505057501,NDC,,,BOTH,,,19.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLOPATADINE 0.1% OP,179114-4,CDM,250,RC,,,46122067264,NDC,,,BOTH,,,19.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETIC ACID 0.25% IR,179417-1,CDM,250,RC,,,264230410,NDC,,,BOTH,,,19.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEMAZEPAM 7.5MG,172394-9,CDM,250,RC,,,68084054921,NDC,,,BOTH,,,19.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AQUAPHOR 3.5OZ-BEIER,172555-5,CDM,250,RC,,,72140003263,NDC,,,BOTH,,,19.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCIMOLONE 0.1% CR,171783-4,CDM,250,RC,,,51672128202,NDC,,,BOTH,,,19.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREON 2400 CAP,171913-7,CDM,250,RC,,,32122401,NDC,,,BOTH,,,19.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZIPRASIDONE 20MG,172147-1,CDM,250,RC,,,68084010309,NDC,,,BOTH,,,19.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PANTAPROZOLE40MG-AUR,179196-1,CDM,250,RC,,,55150020210,NDC,,,BOTH,,,19.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 NS 20MEQ KCL,72866-7,CDM,250,RC,,,990710709,NDC,,,BOTH,,,19.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CA CHLORIDE 10%-HOSP,172573-8,CDM,250,RC,,,409163140,NDC,,,BOTH,,,19.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EUCERIN CREAM,70546-7,CDM,250,RC,,,72140000022,NDC,,,BOTH,,,20.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAL 1.5 CAL 8OZ,172019-2,CDM,250,RC,,,70074064824,NDC,,,BOTH,,,20.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE 5MG/5ML,172333-7,CDM,250,RC,,,66689040101,NDC,,,BOTH,,,20.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 100MG/4ML,179732-3,CDM,250,RC,,,66689003650,NDC,,,BOTH,,,20.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERBINAFINE 1% CREAM,71869-2,CDM,250,RC,,,24385052405,NDC,,,BOTH,,,20.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFEPIME 1GM,179924-6,CDM,250,RC,,,60505614604,NDC,,,BOTH,,,20.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ART TEARS OINT-AKORN,179179-7,CDM,250,RC,,,1747800623,NDC,,,BOTH,,,20.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROCIN 250MG,70537-6,CDM,250,RC,,,24338012203,NDC,,,BOTH,,,20.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 40MG/5ML,172534-0,CDM,250,RC,,,68180015001,NDC,,,BOTH,,,20.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAZA BARRIER CR 5OZ,179532-7,CDM,250,RC,,,11701008224,NDC,,,BOTH,,,20.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ITRACONAZOLE 100MG C,172382-4,CDM,250,RC,,,10147170003,NDC,,,BOTH,,,20.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEVELAMER 800MG,172022-6,CDM,250,RC,,,60687044901,NDC,,,BOTH,,,20.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RENAGEL 800MG TAB,179937-8,CDM,250,RC,,,58468002101,NDC,,,BOTH,,,20.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROSUVASTATIN 5MG TAB,172391-5,CDM,250,RC,,,57237016890,NDC,,,BOTH,,,20.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XARELTO 2.5MG TAB,172515-9,CDM,250,RC,,,50458057710,NDC,,,BOTH,,,20.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAL. CHLOR 10%/10CC,70228-2,CDM,250,RC,,,64253090036,NDC,,,BOTH,,,21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SILVER SULFA 1%,171829-5,CDM,250,RC,,,43598021025,NDC,,,BOTH,,,21.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAPHCON-A EYE DROPS,172206-5,CDM,250,RC,,,65008515,NDC,,,BOTH,,,21.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPHENALATE S 200,172524-1,CDM,250,RC,,,67877023022,NDC,,,BOTH,,,21.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISENTRESS 100MG TAB,179309-0,CDM,250,RC,,,6047761,NDC,,,BOTH,,,21.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEPTAMEN 1.5ML 250ML,171956-6,CDM,250,RC,,,98716008190,NDC,,,BOTH,,,21.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFAMETH 200/40,172426-9,CDM,250,RC,,,121085340,NDC,,,BOTH,,,21.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE100MG,171803-0,CDM,250,RC,,,406839062,NDC,,,BOTH,,,21.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENTRESTO 97MG  TAB,172484-8,CDM,250,RC,,,78069620,NDC,,,BOTH,,,21.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE PATCH 5%,72435-1,CDM,250,RC,,,591352511,NDC,,,BOTH,,,21.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYOXIDE ANTISEPTIC,171977-2,CDM,250,RC,,,42037010476,NDC,,,BOTH,,,21.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REFRESH TEARS,72241-3,CDM,250,RC,,,23079815,NDC,,,BOTH,,,22.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPYLENE GLYCOL500M,179459-3,CDM,250,RC,,,38779051008,NDC,,,BOTH,,,22.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
0.9% NACL IRR 3000ML,70652-3,CDM,250,RC,,,990797208,NDC,,,BOTH,,,23.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ELIQUIS 2.5MG,172235-4,CDM,250,RC,,,3089331,NDC,,,BOTH,,,23.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ELIQUIS 5MG TAB,172502-7,CDM,250,RC,,,3089431,NDC,,,BOTH,,,23.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMLACTIN CR,172509-2,CDM,250,RC,,,245002248,NDC,,,BOTH,,,23.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D51/2NSW/KCL10MEQ,179566-5,CDM,250,RC,,,990799309,NDC,,,BOTH,,,23.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VECURONIUM 10MG SUN,179750-5,CDM,250,RC,,,47335093144,NDC,,,BOTH,,,23.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREON 24000 CAP,179550-9,CDM,250,RC,,,32263601,NDC,,,BOTH,,,23.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLOPROMAZINE 50MG T,172511-8,CDM,250,RC,,,60687044101,NDC,,,BOTH,,,23.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPS 15G/60ML,70799-2,CDM,250,RC,,,46287000660,NDC,,,BOTH,,,23.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENALAPRILAT 2.5MG/2M,71696-9,CDM,250,RC,,,143978610,NDC,,,BOTH,,,24.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENOBARB/BELLADONNA,172060-6,CDM,250,RC,,,66689006301,NDC,,,BOTH,,,24.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE LIQ 60ML,70935-2,CDM,250,RC,,,54329446,NDC,,,BOTH,,,24.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPRED AUT 40MG,172635-5,CDM,250,RC,,,703003104,NDC,,,BOTH,,,24.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIOGLITAZONE 30MG T,172045-7,CDM,250,RC,,,57237022030,NDC,,,BOTH,,,25.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBERSOL,134-7,CDM,250,RC,,,49281075221,NDC,,,BOTH,,,25.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBERSOL,331-9,CDM,250,RC,,,49881075221,NDC,,,BOTH,,,25.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBERSOL,71585-4,CDM,250,RC,,,49281075221,NDC,,,BOTH,,,25.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINE 5MG TAB,172303-0,CDM,250,RC,,,68084072301,NDC,,,BOTH,,,25.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXTROSE 50% 50ML,179120-1,CDM,250,RC,,,409751766,NDC,,,BOTH,,,25.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLCHICINE .6 MG TAB,70282-9,CDM,250,RC,,,60687038921,NDC,,,BOTH,,,26.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UREA 20% CREAM 3OZ,172355-0,CDM,250,RC,,,58980061030,NDC,,,BOTH,,,26.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DESVENLAFAXINEER25MG,179468-4,CDM,250,RC,,,51991000633,NDC,,,BOTH,,,26.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXEDERM CREAM 2OZ,179449-4,CDM,250,RC,,,4783220534,NDC,,,BOTH,,,26.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENTRESTO 49/51 TAB,172529-0,CDM,250,RC,,,78077720,NDC,,,BOTH,,,27.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENTRESTO 24/26 TAB,172581-1,CDM,250,RC,,,78065920,NDC,,,BOTH,,,27.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD BICARB 50MEQ V,71434-5,CDM,250,RC,,,409662502,NDC,,,BOTH,,,27.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICONAZOLE 7 VAG CR,179786-9,CDM,250,RC,,,904773445,NDC,,,BOTH,,,27.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DESVENLAFAXINE ER50M,172477-2,CDM,250,RC,,,54040013,NDC,,,BOTH,,,27.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AQUAPHOR OINT 7OZ BE,179267-0,CDM,250,RC,,,72140001945,NDC,,,BOTH,,,28.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REFRESH OPTIVE GEL10,179434-6,CDM,250,RC,,,23545910,NDC,,,BOTH,,,28.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCRALFATE 1GM/10ML,729004-2,CDM,250,RC,,,121074710,NDC,,,BOTH,,,28.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RESTASIS OPTH 0.05%,171912-9,CDM,250,RC,,,23916330,NDC,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 20MG/50ML,171868-3,CDM,250,RC,,,338519741,NDC,,,BOTH,,,28.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EZETIMIBE 10MG-AHP,179211-8,CDM,250,RC,,,60687037321,NDC,,,BOTH,,,28.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SARNA LOTION 7.5OZ,172517-5,CDM,250,RC,,,54868158700,NDC,,,BOTH,,,29.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISOLONE 5MG/5ML,71349-5,CDM,250,RC,,,62135033041,NDC,,,BOTH,,,29.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEOPHYLLINE 80MG/15,172150-5,CDM,250,RC,,,121482040,NDC,,,BOTH,,,29.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCHLORP 25MG SUPP,70296-9,CDM,250,RC,,,574722612,NDC,,,BOTH,,,29.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TETRACAINE HCL 0.5%,172461-6,CDM,250,RC,,,65074114,NDC,,,BOTH,,,29.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD BICARB 8.4% SYR,171907-9,CDM,250,RC,,,409663734,NDC,,,BOTH,,,30.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TADALAFIL 2.5MG TAB,179378-5,CDM,250,RC,,,31722064330,NDC,,,BOTH,,,30.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERBINAFINE 250MG TA,179371-0,CDM,250,RC,,,51991052601,NDC,,,BOTH,,,30.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHLO OP 3.5GM,719053-1,CDM,250,RC,,,17478062235,NDC,,,BOTH,,,30.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOMYCIN/POLY IRRG,171944-2,CDM,250,RC,,,39822120102,NDC,,,BOTH,,,30.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POLY B 5000,000U-FRE",172630-6,CDM,250,RC,,,63323036711,NDC,,,BOTH,,,30.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ULORIC 40MG,172035-8,CDM,250,RC,,,64764091830,NDC,,,BOTH,,,30.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIMETHOPRIM POLYB E,172268-5,CDM,250,RC,,,24208031510,NDC,,,BOTH,,,31.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIRVANQ 50MG,172475-6,CDM,250,RC,,,65628020810,NDC,,,BOTH,,,31.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NA BICARB 4.2-PFIZER,179741-4,CDM,250,RC,,,409553414,NDC,,,BOTH,,,31.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POLYMYXIN B 500,000U",172172-9,CDM,250,RC,,,70594004901,NDC,,,BOTH,,,31.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MULTAQ 400MG,171955-8,CDM,250,RC,,,24414260,NDC,,,BOTH,,,32.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUDESONIDE 1MG/2ML,172528-2,CDM,250,RC,,,69097032187,NDC,,,BOTH,,,32.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RAMELTON 8MG TAB,179332-2,CDM,250,RC,,,52817023530,NDC,,,BOTH,,,32.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINE ODT 5MG,172232-1,CDM,250,RC,,,59746030632,NDC,,,BOTH,,,33.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINE ODT 5MG-A,179293-6,CDM,250,RC,,,60606327500,NDC,,,BOTH,,,33.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINEODT5MG-APO,179144-1,CDM,250,RC,,,60505327503,NDC,,,BOTH,,,33.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOTRIMIN POWDER 3OZ,179450-2,CDM,250,RC,,,4100587299,NDC,,,BOTH,,,33.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOVANTIK 25MG TAB,172469-9,CDM,250,RC,,,57841130130,NDC,,,BOTH,,,34.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DICLOFENAC GEL,179958-4,CDM,250,RC,,,45802095301,NDC,,,BOTH,,,34.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEN VK 250/5ML 100ML,179728-1,CDM,250,RC,,,93412773,NDC,,,BOTH,,,34.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAPZASIN 0.1% CREAM,179412-2,CDM,250,RC,,,41167075142,NDC,,,BOTH,,,35.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENEPROTEIN PWDR 8OZ,179553-3,CDM,250,RC,,,43900028410,NDC,,,BOTH,,,36.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROZEREM 8MG TAB,179813-1,CDM,250,RC,,,64764080530,NDC,,,BOTH,,,36.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD POLY SULF P 15GM,172665-2,CDM,250,RC,,,11534016616,NDC,,,BOTH,,,36.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAL 1.5 RTH 1000ML,179447-8,CDM,250,RC,,,70074062714,NDC,,,BOTH,,,36.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DALIRESP 500MCG,171914-5,CDM,250,RC,,,310009530,NDC,,,BOTH,,,37.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIT A&D 16OZ-BAYER,179121-9,CDM,250,RC,,,41100081134,NDC,,,BOTH,,,37.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREON 36000 CAP,179355-3,CDM,250,RC,,,32301613,NDC,,,BOTH,,,37.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXTROSE 50%/50CC,70393-4,CDM,250,RC,,,76329330101,NDC,,,BOTH,,,37.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUETIAPINE FUM ER150,172552-2,CDM,250,RC,,,50742063660,NDC,,,BOTH,,,37.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCLOPENTOL ATE 1% O,172105-9,CDM,250,RC,,,24208073501,NDC,,,BOTH,,,38.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRASUGREL 10MG TAB,179484-1,CDM,250,RC,,,60505464303,NDC,,,BOTH,,,38.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRASUGREL 5MG TAB,179485-8,CDM,250,RC,,,60505464203,NDC,,,BOTH,,,38.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYRBETRIQ 25MG,172476-4,CDM,250,RC,,,469260130,NDC,,,BOTH,,,39.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYRBETRIQ 50MG,172454-1,CDM,250,RC,,,469260230,NDC,,,BOTH,,,39.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CIPROFLOXACIN OPTH,172087-9,CDM,250,RC,,,61314065605,NDC,,,BOTH,,,39.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 500MG T,171849-3,CDM,250,RC,,,904635261,NDC,,,BOTH,,,39.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NA BICARB 8.4%,179740-6,CDM,250,RC,,,409490034,NDC,,,BOTH,,,39.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAMIDRONATE 60MG INJ,171937-6,CDM,250,RC,,,61703032518,NDC,,,BOTH,,,39.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRINTELLIX 20MGTAKED,179198-7,CDM,250,RC,,,64764075030,NDC,,,BOTH,,,39.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PANTOPRAZOLE POWDER,171952-5,CDM,250,RC,,,27241025638,NDC,,,BOTH,,,39.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GOLYTELY,170731-4,CDM,250,RC,,,52268010001,NDC,,,BOTH,,,39.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDIHONEY TUBE A 1.5,172372-5,CDM,250,RC,,,9958003361,NDC,,,BOTH,,,40.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZACTAM 500MG 2GM,172356-8,CDM,250,RC,,,3257016,NDC,,,BOTH,,,40.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLYTRIM OPTH,70499-9,CDM,250,RC,,,61314062810,NDC,,,BOTH,,,40.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCONTIN 40MG,72162-1,CDM,250,RC,,,59011044020,NDC,,,BOTH,,,40.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM PHOSPHATE 45M,172400-4,CDM,250,RC,,,409739172,NDC,,,BOTH,,,40.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POLY B 500,000U-AURO",172628-0,CDM,250,RC,,,55150023410,NDC,,,BOTH,,,40.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DESMOPRESSINACET4MCG,179463-5,CDM,250,RC,,,69918089910,NDC,,,BOTH,,,41.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MGSUP,71252-1,CDM,250,RC,,,713052612,NDC,,,BOTH,,,41.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE SUPP TM,71251-3,CDM,250,RC,,,713053612,NDC,,,BOTH,,,41.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIFEREX TAB,179416-3,CDM,250,RC,,,75854032130,NDC,,,BOTH,,,41.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LETROZOLE 2.5MG TAB,179348-8,CDM,250,RC,,,16729003410,NDC,,,BOTH,,,42.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRIMONIDINE 0.2% OP,172500-1,CDM,250,RC,,,24208041105,NDC,,,BOTH,,,42.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMIFLU 75 MG,72190-2,CDM,250,RC,,,4080085,NDC,,,BOTH,,,42.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMMONIUM LACTATE 12%,171808-9,CDM,250,RC,,,45802052555,NDC,,,BOTH,,,42.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEVELAMER 0.8GM PKT,172260-2,CDM,250,RC,,,43598047890,NDC,,,BOTH,,,42.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTH OPTH OINTAKORN,179133-4,CDM,250,RC,,,24208091055,NDC,,,BOTH,,,43.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINZESS 145MCG,172420-2,CDM,250,RC,,,456120130,NDC,,,BOTH,,,43.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINZESS 290MCG,172385-7,CDM,250,RC,,,456120230,NDC,,,BOTH,,,43.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINZESS 72MCG,172499-6,CDM,250,RC,,,456120330,NDC,,,BOTH,,,43.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EES OPTH OINT,70552-5,CDM,250,RC,,,24208091055,NDC,,,BOTH,,,44.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BELSOMRA 10MG TAB,179568-1,CDM,250,RC,,,6003330,NDC,,,BOTH,,,44.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN OPTH DR,70709-1,CDM,250,RC,,,60758018805,NDC,,,BOTH,,,44.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EMTRICITABINE200MG-C,179190-4,CDM,250,RC,,,69097064202,NDC,,,BOTH,,,45.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRADJENTA 5MG,172344-4,CDM,250,RC,,,597014030,NDC,,,BOTH,,,45.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EMYCIN SUSP-WILSHIRE,179126-8,CDM,250,RC,,,52536013413,NDC,,,BOTH,,,45.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFOXITIN 1GM 50ML,171836-0,CDM,250,RC,,,264312311,NDC,,,BOTH,,,45.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JANUVIA 100MG,179844-6,CDM,250,RC,,,6027728,NDC,,,BOTH,,,46.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEO/POLY/DEX OPTH OT,179711-7,CDM,250,RC,,,24208079535,NDC,,,BOTH,,,46.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEO/POLY/DEX OPTH SU,179710-9,CDM,250,RC,,,24208083060,NDC,,,BOTH,,,46.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOTRIM15GMTUBE TARO,179175-5,CDM,250,RC,,,51672127501,NDC,,,BOTH,,,46.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SILDENAFIL 20MG TAB,172336-0,CDM,250,RC,,,68001036305,NDC,,,BOTH,,,46.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROCURONIUM 10MG/ML,179843-8,CDM,250,RC,,,55150022610,NDC,,,BOTH,,,46.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFORMOTEROL 15MCG/2M,172594-4,CDM,250,RC,,,70748017530,NDC,,,BOTH,,,47.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARFORMOTEROL 15MCGNC,172595-1,CDM,250,RC,,,69097016887,NDC,,,BOTH,,,47.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 12MCG PATCH,171918-6,CDM,250,RC,,,47781042347,NDC,,,BOTH,,,47.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOSAMAX 70MG TAB,179345-4,CDM,250,RC,,,64980034214,NDC,,,BOTH,,,47.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINZESS 290MCG CAP,179422-1,CDM,250,RC,,,456120230,NDC,,,BOTH,,,48.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FARXIGA 5MG TAB,172547-2,CDM,250,RC,,,310620530,NDC,,,BOTH,,,48.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JANUVIA 50MG TAB,179362-9,CDM,250,RC,,,6011228,NDC,,,BOTH,,,48.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OFLOXACIN 0.3% OP5ML,72085-4,CDM,250,RC,,,17478071310,NDC,,,BOTH,,,48.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FYCOMPA 2MG,172457-4,CDM,250,RC,,,62856027230,NDC,,,BOTH,,,49.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MELTOPGABBACLID CRM,179557-4,CDM,250,RC,,,0,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 25MGS,70066-6,CDM,250,RC,,,713050324,NDC,,,BOTH,,,50.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JARDIANCE 10MG,172354-3,CDM,250,RC,,,597015230,NDC,,,BOTH,,,51.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAPAGLIFLOZIN 10MG,179483-3,CDM,250,RC,,,66993045730,NDC,,,BOTH,,,51.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAPAGLIFOZIN 5MG TAB,179385-0,CDM,250,RC,,,66993045630,NDC,,,BOTH,,,51.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERFOROMIST,179860-2,CDM,250,RC,,,49502060561,NDC,,,BOTH,,,52.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BROVANA 15MCG NEB,172277-6,CDM,250,RC,,,63402091130,NDC,,,BOTH,,,52.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIRIVA INHALER CAPS,72533-3,CDM,250,RC,,,597007575,NDC,,,BOTH,,,53.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOREPINEPHRINE 4MG,172187-7,CDM,250,RC,,,781375595,NDC,,,BOTH,,,53.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXYCYCLINE 25MG/5ML,172337-8,CDM,250,RC,,,68180065701,NDC,,,BOTH,,,53.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MENTHOL CRYSTALS100G,179458-5,CDM,250,RC,,,38779052105,NDC,,,BOTH,,,53.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVIDENT 5000 SENTP,179491-6,CDM,250,RC,,,126007061,NDC,,,BOTH,,,53.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERPHENAZINE 8MG,71640-7,CDM,250,RC,,,68084060701,NDC,,,BOTH,,,53.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MESALAMINE 4GM ENEMA,172507-6,CDM,250,RC,,,45802009828,NDC,,,BOTH,,,53.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONDANSETRON 4MG ODT,179432-0,CDM,250,RC,,,68001024617,NDC,,,BOTH,,,54.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL PATCH 0.05,179900-6,CDM,250,RC,,,378335099,NDC,,,BOTH,,,54.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYRICA 20MG/ML SOL,172472-3,CDM,250,RC,,,71102001,NDC,,,BOTH,,,54.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCORTISONE 1% LO,179792-7,CDM,250,RC,,,394085932,NDC,,,BOTH,,,55.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LETS KIT,172358-4,CDM,250,RC,,,51552134501,NDC,,,BOTH,,,55.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOBUNOLOL 0.5% OPT,179799-2,CDM,250,RC,,,24208050505,NDC,,,BOTH,,,56.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOPAMINE 400MG/D5,172010-1,CDM,250,RC,,,338100702,NDC,,,BOTH,,,56.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBER GUMMIES-72CT,179394-2,CDM,250,RC,,,37000788591,NDC,,,BOTH,,,56.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOPHED 4MG/4ML-PFZ,179138-3,CDM,250,RC,,,409337504,NDC,,,BOTH,,,56.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JARDIANCE 25MG TAB,179334-8,CDM,250,RC,,,597015337,NDC,,,BOTH,,,57.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCONTIN 60MG,172039-0,CDM,250,RC,,,59011046020,NDC,,,BOTH,,,57.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM BICARB 4.2%IN,179391-8,CDM,250,RC,,,63323008305,NDC,,,BOTH,,,57.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENOBARBITAL IN 65M,172444-2,CDM,250,RC,,,641047625,NDC,,,BOTH,,,58.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL 10%-30,172371-7,CDM,250,RC,,,60687062845,NDC,,,BOTH,,,58.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOKELMA 10G PACKET,172491-3,CDM,250,RC,,,310111039,NDC,,,BOTH,,,61.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN CREAM 30GM,179943-6,CDM,250,RC,,,713067831,NDC,,,BOTH,,,61.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 50MCG PATCH,72782-6,CDM,250,RC,,,406905076,NDC,,,BOTH,,,61.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODAFINIL 100MG TAB,172360-0,CDM,250,RC,,,68084062121,NDC,,,BOTH,,,61.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIMOSAN,71639-9,CDM,250,RC,,,59365503000,NDC,,,BOTH,,,61.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANDIDA,70344-7,CDM,250,RC,,,59584013801,NDC,,,BOTH,,,63.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUMATRIPTAN 25MG T-A,172177-8,CDM,250,RC,,,65862014636,NDC,,,BOTH,,,63.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EUCERIN CREAM 16OZ,179436-1,CDM,250,RC,,,72140000021,NDC,,,BOTH,,,64.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTROGRAFIN 30ML,172017-6,CDM,250,RC,,,270044535,NDC,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIMOLOL 0.25% 10ML,179716-6,CDM,250,RC,,,64980051301,NDC,,,BOTH,,,64.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETAMETHASINE 0.1% C,179805-7,CDM,250,RC,,,168004015,NDC,,,BOTH,,,65.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTSTIN TOP PWDER15,179433-8,CDM,250,RC,,,68382037001,NDC,,,BOTH,,,65.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOKELMA 5 GM PACKET,172560-5,CDM,250,RC,,,310110539,NDC,,,BOTH,,,66.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC TRACE 1MG/ML VIA,179403-1,CDM,250,RC,,,409409011,NDC,,,BOTH,,,66.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COPPER TRACE 4MG/10M,179404-9,CDM,250,RC,,,409409211,NDC,,,BOTH,,,66.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACIT/POLY B OPTH OI,70496-5,CDM,250,RC,,,24208055555,NDC,,,BOTH,,,66.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEPHALEXIN 250/5ML,70886-7,CDM,250,RC,,,93417773,NDC,,,BOTH,,,67.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOMETASONE 01%CR15G,172570-4,CDM,250,RC,,,68462019217,NDC,,,BOTH,,,68.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOCONAZOLE 2% SHAM,172230-5,CDM,250,RC,,,45802046564,NDC,,,BOTH,,,70.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NUEDEXTA 20/10MG CAP,179442-9,CDM,250,RC,,,64597030160,NDC,,,BOTH,,,70.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SILVASORB GEL 1.5OZ,172219-8,CDM,250,RC,,,8327030909,NDC,,,BOTH,,,71.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICARDIPINE 2.5MG10M,171971-5,CDM,250,RC,,,143968901,NDC,,,BOTH,,,71.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CINACALCET 30MG,172531-6,CDM,250,RC,,,69097041002,NDC,,,BOTH,,,71.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCA MORPHINE,71123-4,CDM,250,RC,,,409202902,NDC,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOCONAZOLE 2% CR,172229-7,CDM,250,RC,,,168009915,NDC,,,BOTH,,,72.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFAZOLIN 1 GRAM,70891-7,CDM,250,RC,,,10019061103,NDC,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZOIN TINCTURE,179771-1,CDM,250,RC,,,40565011182,NDC,,,BOTH,,,73.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZITHROMAX SUSP,72023-5,CDM,250,RC,,,69314019,NDC,,,BOTH,,,73.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXYCYCLINE 100MG IN,71689-4,CDM,250,RC,,,63323013011,NDC,,,BOTH,,,73.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARIPIPRAZOLE 10MG,72438-5,CDM,250,RC,,,62332009930,NDC,,,BOTH,,,74.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARIPIPRAZOLE 2MG TAB,172448-3,CDM,250,RC,,,62332009731,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE 0.1MG PTCH,172081-2,CDM,250,RC,,,591350804,NDC,,,BOTH,,,77.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN 0.3% OPTH,179715-8,CDM,250,RC,,,61314064305,NDC,,,BOTH,,,79.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODAFINIL 200MG TAB,172036-6,CDM,250,RC,,,68084072121,NDC,,,BOTH,,,82.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 50MG,179772-9,CDM,250,RC,,,713013212,NDC,,,BOTH,,,83.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VELTASSA 25.2 GM PAC,172540-7,CDM,250,RC,,,53436025230,NDC,,,BOTH,,,83.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MY WAY 1.5MG TAB,72810-5,CDM,250,RC,,,68180085211,NDC,,,BOTH,,,85.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RILUZOLE 50MG,172512-6,CDM,250,RC,,,67877028660,NDC,,,BOTH,,,86.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETHYL CHLORIDE,179765-3,CDM,250,RC,,,386000104,NDC,,,BOTH,,,86.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENELEX OINTMENT 60G,172367-5,CDM,250,RC,,,58980078021,NDC,,,BOTH,,,87.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMMONIUMLAC225GM-MAJ,179187-0,CDM,250,RC,,,904598426,NDC,,,BOTH,,,89.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERAPAMIL 2.5MG/ML,179754-7,CDM,250,RC,,,409114402,NDC,,,BOTH,,,89.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERAPAMIL 5MG/2MLINJ,179452-8,CDM,250,RC,,,51754020302,NDC,,,BOTH,,,90.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN OPTH OINT,70485-8,CDM,250,RC,,,17478028435,NDC,,,BOTH,,,91.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORDANSETRON 8MG-RISI,172634-8,CDM,250,RC,,,57237007630,NDC,,,BOTH,,,91.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAZOLAMIDE 500MG,179259-7,CDM,250,RC,,,39822019001,NDC,,,BOTH,,,92.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL 2MG/ML,70791-9,CDM,250,RC,,,54838050115,NDC,,,BOTH,,,93.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETIC ACID 2% OTIC,179722-4,CDM,250,RC,,,50383088915,NDC,,,BOTH,,,93.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARTEOLOL 1% OPTH,72140-7,CDM,250,RC,,,61314023810,NDC,,,BOTH,,,93.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 75 MCG PATCH,72783-4,CDM,250,RC,,,378912398,NDC,,,BOTH,,,94.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCLOPENTOLATE 1%,179304-1,CDM,250,RC,,,61314039603,NDC,,,BOTH,,,94.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPARACAINE0.5%OPTH,72828-7,CDM,250,RC,,,24208073006,NDC,,,BOTH,,,98.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITRO-BID 2% OINT,72799-0,CDM,250,RC,,,281032630,NDC,,,BOTH,,,99.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUPIROCIN 2% OINT,719133-1,CDM,250,RC,,,68462018022,NDC,,,BOTH,,,99.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM LIQUID/CC,72073-0,CDM,250,RC,,,54318544,NDC,,,BOTH,,,100.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TET & DIPTH TOXOID,146-1,CDM,250,RC,,,49281021515,NDC,,,BOTH,,,100.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TET & DIPTH TOXOID,304-6,CDM,250,RC,,,49281021515,NDC,,,BOTH,,,100.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TET & DIPTH TOXOID,71529-2,CDM,250,RC,,,49281021515,NDC,,,BOTH,,,100.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETIC ACID 500MLBAG,179479-1,CDM,250,RC,,,264230410,NDC,,,BOTH,,,101.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QULIPTA 60MG TAB,179472-6,CDM,250,RC,,,74709530,NDC,,,BOTH,,,102.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VORICONAZOLE 200MG,724864-4,CDM,250,RC,,,781566831,NDC,,,BOTH,,,109.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VORICONAZOLE 200MG T,172306-3,CDM,250,RC,,,68084053825,NDC,,,BOTH,,,109.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACROLIMUS0.1%OINT,179408-0,CDM,250,RC,,,68462053435,NDC,,,BOTH,,,111.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIMOLOL 0.5% OP 15ML,179705-9,CDM,250,RC,,,17478028812,NDC,,,BOTH,,,113.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN CR 0.1%-C,172596-9,CDM,250,RC,,,713068315,NDC,,,BOTH,,,115.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN CR 0.1%,179763-8,CDM,250,RC,,,45802005635,NDC,,,BOTH,,,115.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN OINT 15GM,179766-1,CDM,250,RC,,,45802004635,NDC,,,BOTH,,,115.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROMYCIN 2%,179764-6,CDM,250,RC,,,45802003846,NDC,,,BOTH,,,116.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIREAD 300MG,172316-2,CDM,250,RC,,,61958040101,NDC,,,BOTH,,,117.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VELTASSA 8.4GM,172338-6,CDM,250,RC,,,53436008404,NDC,,,BOTH,,,117.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VRAYLAR 1.5MG CAP,172559-7,CDM,250,RC,,,61874011520,NDC,,,BOTH,,,118.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DONNATAL ELX UD,172653-8,CDM,250,RC,,,66689006310,NDC,,,BOTH,,,121.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCTOFOAM 1%,179782-8,CDM,250,RC,,,51862018015,NDC,,,BOTH,,,122.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRALIPID 20% 250ML,172397-2,CDM,250,RC,,,338051909,NDC,,,BOTH,,,123.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE/PRI 2.5% C,179917-0,CDM,250,RC,,,50386066730,NDC,,,BOTH,,,124.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 100MCG PATC,72784-2,CDM,250,RC,,,406900076,NDC,,,BOTH,,,124.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 25MCG PATCH,72781-8,CDM,250,RC,,,378912498,NDC,,,BOTH,,,124.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN POWDER 30GM,72003-7,CDM,250,RC,,,574200830,NDC,,,BOTH,,,125.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINIMIX E 5-15% BAG,179401-5,CDM,250,RC,,,338114703,NDC,,,BOTH,,,126.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NARCAN HCL NASAL,179488-2,CDM,250,RC,,,69547062702,NDC,,,BOTH,,,126.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NARCAN HCL NASAL,390-5,CDM,250,RC,,,69547062702,NDC,,,BOTH,,,126.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XIFAXAN 550MG,172005-1,CDM,250,RC,,,65649030303,NDC,,,BOTH,,,128.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNISONE ACETATE,179830-5,CDM,250,RC,,,61314063705,NDC,,,BOTH,,,129.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMNIPAQUE 240 10 CC,71996-3,CDM,250,RC,,,407141110,NDC,,,BOTH,,,130.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLIOTRIMAZOL/BETAMET,171770-1,CDM,250,RC,,,68462029817,NDC,,,BOTH,,,131.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRALIPID 20% INJ,179402-3,CDM,250,RC,,,338051909,NDC,,,BOTH,,,132.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DONNATAL ELIXER 5ML,179418-9,CDM,250,RC,,,66689006310,NDC,,,BOTH,,,132.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADACEL (DTAP),171819-6,CDM,250,RC,,,49281040020,NDC,,,BOTH,,,134.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 250MG CAP,172247-9,CDM,250,RC,,,121089020,NDC,,,BOTH,,,134.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINDAMYCIN PHOS1%,179297-7,CDM,250,RC,,,45802056202,NDC,,,BOTH,,,135.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BD ULTRA PEN NEEDLES,179868-5,CDM,250,RC,,,8290320119,NDC,,,BOTH,,,138.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REXULTI 2MG TAB,179529-3,CDM,250,RC,,,59148003813,NDC,,,BOTH,,,141.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFACETAMIDE 10% OP,179707-5,CDM,250,RC,,,24208067004,NDC,,,BOTH,,,142.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSPORIN/OPTH SOL G,71150-7,CDM,250,RC,,,24208079062,NDC,,,BOTH,,,144.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 4% T 50ML,172430-1,CDM,250,RC,,,527600480,NDC,,,BOTH,,,151.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETH OPTH 5ML,70363-7,CDM,250,RC,,,24208072002,NDC,,,BOTH,,,151.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEO/POLY/BAC/HCT OP,179709-1,CDM,250,RC,,,24208078555,NDC,,,BOTH,,,152.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETAX 0.5% EYE DROP,70213-4,CDM,250,RC,,,61314024501,NDC,,,BOTH,,,154.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DORZOLAMIDE 2% OPTH,172298-2,CDM,250,RC,,,61314001910,NDC,,,BOTH,,,156.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DORZOLAMIDE 2% MICRO,179130-0,CDM,250,RC,,,42571014126,NDC,,,BOTH,,,156.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DALFAMPRIDINE ER10MG,179353-8,CDM,250,RC,,,591253360,NDC,,,BOTH,,,156.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUMIN 25% 50ML,172331-1,CDM,250,RC,,,68982064301,NDC,,,BOTH,,,161.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANEXAMIC ACID PWD,179460-1,CDM,250,RC,,,38779321104,NDC,,,BOTH,,,166.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUNISOLIDE NASAL,179691-1,CDM,250,RC,,,24208034425,NDC,,,BOTH,,,168.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CETACAINE SPRAY,70328-0,CDM,250,RC,,,10223020103,NDC,,,BOTH,,,169.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CETACAINE SPY 5GM-SI,179106-0,CDM,250,RC,,,10223020104,NDC,,,BOTH,,,171.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL SU INH 200,172516-7,CDM,250,RC,,,254100752,NDC,,,BOTH,,,173.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOTRIMAZOLE 1% SOLU,179785-1,CDM,250,RC,,,51672126003,NDC,,,BOTH,,,174.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHLOR 0.45%/ML,70643-2,CDM,250,RC,,,990798509,NDC,,,BOTH,,,176.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TADALAFIL 20MG TAB,179257-1,CDM,250,RC,,,33342027809,NDC,,,BOTH,,,178.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINEZOLID 600MG TAB,179192-0,CDM,250,RC,,,67877041984,NDC,,,BOTH,,,183.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCINOLONE DENT P,179789-3,CDM,250,RC,,,64980032005,NDC,,,BOTH,,,188.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XOPENEX HFA,171901-2,CDM,250,RC,,,63402051001,NDC,,,BOTH,,,191.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERIPARATIDE 560MCG,179547-5,CDM,250,RC,,,93110616,NDC,,,BOTH,,,198.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DANTROLENE 20MG I-H,172582-9,CDM,250,RC,,,143929701,NDC,,,BOTH,,,198.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUTICASONE 50MCG NS,179931-1,CDM,250,RC,,,60505082901,NDC,,,BOTH,,,199.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOROMETHOLONE 0.1%,179712-5,CDM,250,RC,,,60758088005,NDC,,,BOTH,,,199.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINDAMYCIN GEL 1%,172609-0,CDM,250,RC,,,59762374301,NDC,,,BOTH,,,201.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROMYCIN 2% GEL,179206-8,CDM,250,RC,,,45802096696,NDC,,,BOTH,,,202.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 370 76% 75ML,172389-9,CDM,250,RC,,,270131652,NDC,,,BOTH,,,206.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUTORPHANOL NASAL SPRAY,179751-3,CDM,250,RC,,,54309036,NDC,,,BOTH,,,211,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LANTANOPROST,172309-7,CDM,250,RC,,,61314054701,NDC,,,BOTH,,,222.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROVENTIL INH 6.7GM,719016-8,CDM,250,RC,,,85113201,NDC,,,BOTH,,,223.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IPRATROPIUM BROMID N,172490-5,CDM,250,RC,,,54004641,NDC,,,BOTH,,,223.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN POWDER 60GM,179266-2,CDM,250,RC,,,574200802,NDC,,,BOTH,,,224.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERCONAZOLE SUPP 3,71389-1,CDM,250,RC,,,45802071708,NDC,,,BOTH,,,228.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PILOCARPINE 1%,70840-4,CDM,250,RC,,,61314020315,NDC,,,BOTH,,,230.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PILOCARPINE 2% DROPS,172427-7,CDM,250,RC,,,61314020415,NDC,,,BOTH,,,235.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZELASTINE NASAL,172064-8,CDM,250,RC,,,60505083305,NDC,,,BOTH,,,246.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC OP 0.5%5ML,172046-5,CDM,250,RC,,,61314012605,NDC,,,BOTH,,,246.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PILOCARPINE 4%,70842-0,CDM,250,RC,,,61314020615,NDC,,,BOTH,,,247.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 61% 100ML,171973-1,CDM,250,RC,,,270131535,NDC,,,BOTH,,,247.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 61% 100ML,172243-8,CDM,250,RC,,,270131535,NDC,,,BOTH,,,247.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DANTRIUM 20MG VIAL,172474-9,CDM,250,RC,,,42023012306,NDC,,,BOTH,,,248.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOCINONIDE 0.05%,171880-8,CDM,250,RC,,,64980045206,NDC,,,BOTH,,,249.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONUROL 3GM,172410-3,CDM,250,RC,,,456430001,NDC,,,BOTH,,,256.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREDNIS ACET 1% 10ML,179315-7,CDM,250,RC,,,61314063710,NDC,,,BOTH,,,258.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN/TRIA CR15GM,172698-3,CDM,250,RC,,,68462031417,NDC,,,BOTH,,,261.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYLEPHRINE 2.5% O,172252-9,CDM,250,RC,,,17478020115,NDC,,,BOTH,,,263.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE100MCG,172601-7,CDM,250,RC,,,70860045110,NDC,,,BOTH,,,265.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM THIO 250MG,179546-7,CDM,250,RC,,,60267070550,NDC,,,BOTH,,,271.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 370 100ML 76%,171920-2,CDM,250,RC,,,270131635,NDC,,,BOTH,,,274.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERMETHRIN 5%,72249-6,CDM,250,RC,,,21922002107,NDC,,,BOTH,,,275.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERMETHRIN 5% CR-ENA,172690-0,CDM,250,RC,,,21922002107,NDC,,,BOTH,,,275.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCITONIN NASAL,172145-5,CDM,250,RC,,,49884016111,NDC,,,BOTH,,,277.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN-DEX OPTH,172565-4,CDM,250,RC,,,24208029505,NDC,,,BOTH,,,284.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DORZO-TIMOLOL D OPTH,172102-6,CDM,250,RC,,,50383023310,NDC,,,BOTH,,,286.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRITIC AID PASTE,171776-8,CDM,250,RC,,,11704005032,NDC,,,BOTH,,,286.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERMETHRIN 5% CR-TEV,172689-2,CDM,250,RC,,,472024260,NDC,,,BOTH,,,289.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UBRELVY 50MG TAB,179473-4,CDM,250,RC,,,23649810,NDC,,,BOTH,,,289.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOBETASOL 0.05% CR,171950-9,CDM,250,RC,,,51672125801,NDC,,,BOTH,,,299.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 2% JELLY,171939-2,CDM,250,RC,,,17478071130,NDC,,,BOTH,,,300.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUPREP BOWEL KIT,179342-1,CDM,250,RC,,,52268001201,NDC,,,BOTH,,,305.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NURTEC ODT 75MG TAB,179325-6,CDM,250,RC,,,72618300002,NDC,,,BOTH,,,322.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN 300MG NEB,172543-1,CDM,250,RC,,,65162091446,NDC,,,BOTH,,,330.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIMETHYL FUMARAT 240,179352-0,CDM,250,RC,,,16729041712,NDC,,,BOTH,,,347.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM RECT GL-B&L,172586-0,CDM,250,RC,,,68682065020,NDC,,,BOTH,,,358.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SELENIUM SULF 2.25%,179311-6,CDM,250,RC,,,70156011118,NDC,,,BOTH,,,368.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN/TRIA CR30GM,179682-0,CDM,250,RC,,,68462031435,NDC,,,BOTH,,,372.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MENACTRA 4MCG/0.5ML,171856-8,CDM,250,RC,,,49281058905,NDC,,,BOTH,,,377.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 370 150ML,171943-4,CDM,250,RC,,,270131637,NDC,,,BOTH,,,379.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANDAZOLE,71838-7,CDM,250,RC,,,245086070,NDC,,,BOTH,,,381.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOXIFLOXACIN 0.5% EG,179351-2,CDM,250,RC,,,60505058204,NDC,,,BOTH,,,391.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERIDONE 1MG/ML,72417-9,CDM,250,RC,,,54006344,NDC,,,BOTH,,,392.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CICLOPIROX 8% TOP,179380-1,CDM,250,RC,,,45802014167,NDC,,,BOTH,,,394.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CORTISPORIN OP SUS G,70304-1,CDM,250,RC,,,61314064175,NDC,,,BOTH,,,398.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UREA 40MG CREAM,171970-7,CDM,250,RC,,,44523061707,NDC,,,BOTH,,,402.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 40MG/5ML,179113-6,CDM,250,RC,,,68382044405,NDC,,,BOTH,,,413.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VARIVAX,171857-6,CDM,250,RC,,,6482700,NDC,,,BOTH,,,423.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINEZOLID 600MG TAB,72553-1,CDM,250,RC,,,67877041984,NDC,,,BOTH,,,429.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOCINOLONE 0.01%SO,171945-9,CDM,250,RC,,,21922000301,NDC,,,BOTH,,,438.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCTOFOAM HC,71284-4,CDM,250,RC,,,37682210,NDC,,,BOTH,,,440.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAVRET 100/40MG TAB,179533-5,CDM,250,RC,,,74262528,NDC,,,BOTH,,,440.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRIMONIDINE 0.15%5ML,179890-9,CDM,250,RC,,,61314014405,NDC,,,BOTH,,,448.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRED G OPTH 5ML,171906-1,CDM,250,RC,,,23010605,NDC,,,BOTH,,,450.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLEPHAMIDE 0.2% OP S,71709-0,CDM,250,RC,,,11980002205,NDC,,,BOTH,,,450.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAVOPROST 0.004% OP,172564-7,CDM,250,RC,,,378965132,NDC,,,BOTH,,,463.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETIC ACID HC 10ML,179796-8,CDM,250,RC,,,50383090110,NDC,,,BOTH,,,470.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIASTAT RECTAL 10MG,72093-8,CDM,250,RC,,,187065820,NDC,,,BOTH,,,492.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRIMONIDE-TIMO101 OS,179261-3,CDM,250,RC,,,60505622500,NDC,,,BOTH,,,518.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VEOZAH 45MG,179559-0,CDM,250,RC,,,469266030,NDC,,,BOTH,,,520.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIFLURIDINE OPTH,172307-1,CDM,250,RC,,,61314004475,NDC,,,BOTH,,,521.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIFLUPREDNATE 0.25%E,179438-7,CDM,250,RC,,,43598058811,NDC,,,BOTH,,,524.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BYDUREON PEN,172257-8,CDM,250,RC,,,310653004,NDC,,,BOTH,,,531.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMBIGAN OPTH,171769-3,CDM,250,RC,,,23921105,NDC,,,BOTH,,,545.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIMOLOL MALE.25% GFS,179317-3,CDM,250,RC,,,62332054505,NDC,,,BOTH,,,567.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DESMOPRESSIN NASAL,172111-7,CDM,250,RC,,,47335078891,NDC,,,BOTH,,,575.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPI PEN 0.15MG,389-7,CDM,250,RC,,,115169549,NDC,,,BOTH,,,577.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPI PEN 0.3MG,391-3,CDM,250,RC,,,115169449,NDC,,,BOTH,,,577.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEMOZOLOMIDE 100MG,179382-7,CDM,250,RC,,,47335089274,NDC,,,BOTH,,,589.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRULICITY 0.75MG PEN,172537-3,CDM,250,RC,,,2143380,NDC,,,BOTH,,,592.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRULICITY 1.5MG PEN,172521-7,CDM,250,RC,,,2143480,NDC,,,BOTH,,,592.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRULICITY 3MG,172557-1,CDM,250,RC,,,2223680,NDC,,,BOTH,,,592.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRULICITY 4.5MG PEN,172558-9,CDM,250,RC,,,2318280,NDC,,,BOTH,,,592.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CILOXAN 0.3%,179845-3,CDM,250,RC,,,65065435,NDC,,,BOTH,,,601.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBREX OINT,179708-3,CDM,250,RC,,,65064435,NDC,,,BOTH,,,601.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMIGAN 0.01% OPTH,172330-3,CDM,250,RC,,,23320503,NDC,,,BOTH,,,609.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYMBICORT 80/4.5,171850-1,CDM,250,RC,,,186037228,NDC,,,BOTH,,,615.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUVITE,71107-7,CDM,250,RC,,,54643564901,NDC,,,BOTH,,,618.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XALATAN OPTH,72094-6,CDM,250,RC,,,13830304,NDC,,,BOTH,,,629.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRADEX EYE OINT,72801-4,CDM,250,RC,,,65064835,NDC,,,BOTH,,,640.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CORTISPORIN TC OTIC,172539-9,CDM,250,RC,,,63481052910,NDC,,,BOTH,,,649.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOUNJARO 2.5MG PFP,179341-3,CDM,250,RC,,,2150680,NDC,,,BOTH,,,683.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOUNJARO 5MGPFP0.5ML,179343-9,CDM,250,RC,,,2149580,NDC,,,BOTH,,,683.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIFICID 200MG TAB,172525-8,CDM,250,RC,,,480259634,NDC,,,BOTH,,,693.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYMBICORT 160/4.5,179821-4,CDM,250,RC,,,186037028,NDC,,,BOTH,,,708.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOUNJARO 7.5MG,179429-6,CDM,250,RC,,,2148480,NDC,,,BOTH,,,717.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SANTYL OINTMENT,72125-8,CDM,250,RC,,,50484001030,NDC,,,BOTH,,,732.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 5%O35.44O,172572-0,CDM,250,RC,,,52565000814,NDC,,,BOTH,,,740.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE5% OINT-ST,179230-8,CDM,250,RC,,,64380078932,NDC,,,BOTH,,,740.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOUNJARO 10MG 0.5ML,179469-2,CDM,250,RC,,,2147180,NDC,,,BOTH,,,749.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOUNJARO 12.5MG PFP,179486-6,CDM,250,RC,,,2146030,NDC,,,BOTH,,,749.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYERINSP0.4MCG,719050-7,CDM,250,RC,,,45802021002,NDC,,,BOTH,,,830.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL 0.01%VAGCR,179521-0,CDM,250,RC,,,93354143,NDC,,,BOTH,,,839.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRINZOLAMIDE 1% OPTH,172567-0,CDM,250,RC,,,781601470,NDC,,,BOTH,,,855.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETOPTIC S 0.25% 10M,179694-5,CDM,250,RC,,,65024610,NDC,,,BOTH,,,871.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CIPRO HC OTIC,171800-6,CDM,250,RC,,,65853110,NDC,,,BOTH,,,886.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TIMOLOL XE 0.5% GEL,179704-2,CDM,250,RC,,,62332054605,NDC,,,BOTH,,,888.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROLENSA 0.07% SOL 3,179407-2,CDM,250,RC,,,24208060203,NDC,,,BOTH,,,904.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACYCLOVIR 5% OINT 15,179406-4,CDM,250,RC,,,72578008201,NDC,,,BOTH,,,932.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUDESONIDE 160-4.5,179373-6,CDM,250,RC,,,310737020,NDC,,,BOTH,,,942.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZOPT 1% OPTH,72267-8,CDM,250,RC,,,65027510,NDC,,,BOTH,,,963.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZIRGAN 0.15%,172063-0,CDM,250,RC,,,24208053535,NDC,,,BOTH,,,1107.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN VAG CREAM,71277-8,CDM,250,RC,,,46087221,NDC,,,BOTH,,,1133.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZENPEP PANCRELIPASE,179330-6,CDM,250,RC,,,73562011401,NDC,,,BOTH,,,1282.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METRONIDOZOLE 0.75%C,179545-9,CDM,250,RC,,,713063337,NDC,,,BOTH,,,1285.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 500MCG,179739-8,CDM,250,RC,,,63323024810,NDC,,,BOTH,,,1287.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NATACYN 5% OPTH,172481-4,CDM,250,RC,,,65064515,NDC,,,BOTH,,,1328.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCINOLONE SPRAY,70905-5,CDM,250,RC,,,64980042963,NDC,,,BOTH,,,1337.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REMDESIVIR 100MG-V G,172663-7,CDM,250,RC,,,61958290102,NDC,,,BOTH,,,1458.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACYCLOVIR 5% OINTMEN,172215-6,CDM,250,RC,,,591115930,NDC,,,BOTH,,,1795.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BYETTA 250MCG 2.4ML,172445-9,CDM,250,RC,,,310652401,NDC,,,BOTH,,,2182.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OZEMPIC 0.25MG-0.5MG,172584-5,CDM,250,RC,,,169413212,NDC,,,BOTH,,,2389.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OZEMPIC 1MG PFP-3ML,172589-4,CDM,250,RC,,,169413013,NDC,,,BOTH,,,2389.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OZEMPIC 2MG,179327-2,CDM,250,RC,,,169477212,NDC,,,BOTH,,,2502.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FERAHEME 510MG/17ML,171915-2,CDM,250,RC,,,59338077501,NDC,,,BOTH,,,3348.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAXLOVID 300/100MG T,179530-1,CDM,250,RC,,,69532130,NDC,,,BOTH,,,4197.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIVENIN CROTA,70060-9,CDM,250,RC,,,50633011012,NDC,,,BOTH,,,8972.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 50CC,72505-1,CDM,255,RC,,,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 50CC,72506-9,CDM,255,RC,,,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYSTOGRAFIN,52007-2,CDM,255,RC,,,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTROVIEW,82874-9,CDM,255,RC,,,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE M 300,71995-5,CDM,255,RC,,,,,,,BOTH,,,193,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 100CC,72507-7,CDM,255,RC,,,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOVUE 300 100CC,72508-5,CDM,255,RC,,,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 20MEQ KCL 1000ML,171844-4,CDM,258,RC,S5012,HCPCS,990790509,NDC,,,BOTH,,,20.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 1/2 ST SOL/M CC,70620-0,CDM,258,RC,S5010,HCPCS,990792609,NDC,,,BOTH,,,14.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 LR/M CC,70623-4,CDM,258,RC,J7121,HCPCS,338012504,NDC,,,BOTH,,,14.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 SALINE/M CC,70622-6,CDM,258,RC,J7042,HCPCS,338008904,NDC,,,BOTH,,,5.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEX 5%/WATER 250CC,70650-7,CDM,258,RC,,,338001702,NDC,,,BOTH,,,10.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D10 WATER/M CC,70625-9,CDM,258,RC,,,409793009,NDC,,,BOTH,,,14.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5 1/4 ST SOL/M CC,70619-2,CDM,258,RC,,,338007704,NDC,,,BOTH,,,15.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASCORBIC ACID 500,70085-6,CDM,259,RC,,,904052361,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 325MG TAB,70081-5,CDM,259,RC,,,66553000101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATENOLOL 25 MG,72276-9,CDM,259,RC,,,51079075920,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZTROPINE 1MG,70338-9,CDM,259,RC,,,904105661,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOTHYROXINE 100MCG,71470-9,CDM,259,RC,,,51079044201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"VITAMIN A 10,000 CAP",179847-9,CDM,259,RC,,,904208560,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B12 1000MCG,179809-9,CDM,259,RC,,,10006070022,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONAZEPAM 0.5MG,70903-0,CDM,259,RC,,,60687054401,NDC,,,BOTH,,,1.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMIDONE 50MG TAB,179941-0,CDM,259,RC,,,68084020211,NDC,,,BOTH,,,1.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NYSTATIN SUSP/5CC,71197-8,CDM,259,RC,,,66689003701,NDC,,,BOTH,,,2.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENSURE PUDDING 4 OZ.,72837-8,CDM,259,RC,,,7007454844,NDC,,,BOTH,,,2.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCOD/APAP 5/325,719017-6,CDM,259,RC,,,68084035501,NDC,,,BOTH,,,3.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 300MG SUPP,179773-7,CDM,259,RC,,,574703412,NDC,,,BOTH,,,3.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATENOLOL 50MG,71521-9,CDM,259,RC,,,51079068420,NDC,,,BOTH,,,4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCLOBENZAPRINE 10MG,70609-3,CDM,259,RC,,,43547040010,NDC,,,BOTH,,,4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENLAFAXINE 37.5MG TABLET,179919-6,CDM,259,RC,,,68382001901,NDC,,,BOTH,,,4.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENLAFAXINE 50MG,179153-2,CDM,259,RC,,,68382002001,NDC,,,BOTH,,,4.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CITRATE MAG/10 OZ,70268-8,CDM,259,RC,,,904678744,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE 10MG,72274-4,CDM,259,RC,,,904578461,NDC,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CITALOPRAM 20MG,72129-0,CDM,259,RC,,,904608561,NDC,,,BOTH,,,6.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALTREX 500 MG,72055-7,CDM,259,RC,,,173093308,NDC,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRAVASTATIN 20MG,71859-3,CDM,259,RC,,,60687017811,NDC,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URSODIOL 300 MG,72363-5,CDM,259,RC,,,68084021301,NDC,,,BOTH,,,8.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAMCINOLONE0.025%C,179790-1,CDM,259,RC,,,45802006335,NDC,,,BOTH,,,10.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOBUNOLOL 0.25% OPTH,179693-7,CDM,259,RC,,,24208054505,NDC,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYBUTYNIN 5MG,70454-4,CDM,259,RC,,,904282161,NDC,,,BOTH,,,14.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYSTANO LUB OP DROP,72548-1,CDM,259,RC,,,65042915,NDC,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALMOSEPTIVE OINT,72558-0,CDM,259,RC,,,799000104,NDC,,,BOTH,,,17.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN A&D OINTMENT,72392-4,CDM,259,RC,,,45802039504,NDC,,,BOTH,,,18.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PULMICORT NEB,719092-9,CDM,259,RC,,,186198904,NDC,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CROMOLYN SODIUM NASAL SPRAY 26ML,179701-8,CDM,259,RC,,,57782039726,NDC,,,BOTH,,,31.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UREA 10% LOTION,179770-3,CDM,259,RC,,,38485098018,NDC,,,BOTH,,,33.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROMYCIN OPT OIN,70482-5,CDM,259,RC,,,574402435,NDC,,,BOTH,,,41.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 20MG TAB,71315-6,CDM,259,RC,,,50268030315,NDC,,,BOTH,,,43.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROMYCIN SU 200M,719098-6,CDM,259,RC,,,62559063001,NDC,,,BOTH,,,47.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSDERM SCOPE,72080-5,CDM,259,RC,,,11019055303,NDC,,,BOTH,,,59.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUPHENAZINE 2.5MG/5ML 60ML,179727-3,CDM,259,RC,,,121065402,NDC,,,BOTH,,,61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 125 PO,70566-5,CDM,259,RC,,,121086720,NDC,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CROMOLYN 4% EYE DROPS,71977-3,CDM,259,RC,,,61314023710,NDC,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATROPINE EYE DROPS 5ML,72830-3,CDM,259,RC,,,65030355,NDC,,,BOTH,,,135.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEO/POLY B/HC OTIC,70305-8,CDM,259,RC,,,61314064610,NDC,,,BOTH,,,245.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PASSY MUIR SPEAK VAL,60107-0,CDM,270,RC,L8501,HCPCS,,,,,BOTH,,,350,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORTHO GLASS SHORT ARM SPLINT,82579-4,CDM,270,RC,29125,CPT,,,,,BOTH,,,139.75,,,73,,121,242,242,1 through 10,percent of total billed charges,,,73,,121,242,242,1 through 10,percent of total billed charges,,,73,,121,242,242,1 through 10,percent of total billed charges,,,73,,121,242,242,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PED. URINE COLLECTOR,80251-2,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TONGUE BLADES STERIL,83071-1,CDM,270,RC,,,,,,,BOTH,,,0.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPONGE 4X4 2PK,80076-3,CDM,270,RC,,,,,,,BOTH,,,0.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
2X2 GAUZE N/S 16 PLY,80074-8,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
4X4 GAUZE N/S 16-PLY,80075-5,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUTTERFLY CLOS. A/S,80021-9,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERILE Q-TIPS,82269-2,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAMPONS,81937-5,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOOTHETTES,82755-0,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE STRAINERS,80183-7,CDM,270,RC,,,,,,,BOTH,,,0.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERILE 5N1 CONNECT,83385-5,CDM,270,RC,,,,,,,BOTH,,,0.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SURG STER #10,82042-3,CDM,270,RC,,,,,,,BOTH,,,0.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERI PAD 3 X 3,82431-8,CDM,270,RC,,,,,,,BOTH,,,0.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SURG STER #11,82043-1,CDM,270,RC,,,,,,,BOTH,,,0.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SURG STER #12,82044-9,CDM,270,RC,,,,,,,BOTH,,,0.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY ORAL 70MM CLD,83362-4,CDM,270,RC,,,,,,,BOTH,,,0.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALLPURPOSE 14FR,82136-3,CDM,270,RC,,,,,,,BOTH,,,0.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALLPURPOSE 18FR,82137-1,CDM,270,RC,,,,,,,BOTH,,,0.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABD COMBINE DRESSING,80001-1,CDM,270,RC,,,,,,,BOTH,,,0.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ADAPTER,82726-1,CDM,270,RC,,,,,,,BOTH,,,0.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SURG STER #15,82045-6,CDM,270,RC,,,,,,,BOTH,,,1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EMESIS BASIN,DISP",860641-0,CDM,270,RC,,,,,,,BOTH,,,1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE FEEDING,80210-8,CDM,270,RC,,,,,,,BOTH,,,1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TELFA DRESSING 2X3.5LF,82987-9,CDM,270,RC,,,,,,,BOTH,,,1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TISSUES, FACIAL",860615-4,CDM,270,RC,,,,,,,BOTH,,,1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPONGE 4X4 TRAY,82300-5,CDM,270,RC,,,,,,,BOTH,,,1.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALLPURPOSE 22FR,82138-9,CDM,270,RC,,,,,,,BOTH,,,1.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING ADAPTIC,80248-8,CDM,270,RC,,,,,,,BOTH,,,1.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRSG XEROFORM 1X8,83175-0,CDM,270,RC,,,,,,,BOTH,,,1.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BODY WASH,82851-7,CDM,270,RC,,,,,,,BOTH,,,1.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EYE PADS,80065-6,CDM,270,RC,,,,,,,BOTH,,,1.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGES 6CC NT RTN,80116-7,CDM,270,RC,,,,,,,BOTH,,,1.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XEROFOAM GAUZE,82474-8,CDM,270,RC,,,,,,,BOTH,,,1.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY INFANT,82022-5,CDM,270,RC,,,,,,,BOTH,,,1.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY LARGE,82026-6,CDM,270,RC,,,,,,,BOTH,,,1.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY MEDIUM,82025-8,CDM,270,RC,,,,,,,BOTH,,,1.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY SMALL,82024-1,CDM,270,RC,,,,,,,BOTH,,,1.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 5/6,82167-8,CDM,270,RC,,,,,,,BOTH,,,1.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORA-PREP SWABSTICK,82976-2,CDM,270,RC,,,,,,,BOTH,,,1.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETADINE SWABS,82715-4,CDM,270,RC,,,,,,,BOTH,,,1.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SHORT BEVEL",82828-5,CDM,270,RC,,,,,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIMEN CONTAINER,80104-3,CDM,270,RC,,,,,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERILE CAP,83301-2,CDM,270,RC,,,,,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURESITE IV DRESSING,82942-4,CDM,270,RC,,,,,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WASH BASIN,82858-2,CDM,270,RC,,,,,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALL PURPOSE 8FR,82133-0,CDM,270,RC,,,,,,,BOTH,,,1.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPONGE RAYTEC STERILE,82969-7,CDM,270,RC,,,,,,,BOTH,,,1.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALLPURPOSE 10FR,82134-8,CDM,270,RC,,,,,,,BOTH,,,1.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRSG XEROFORM 4X4,83193-3,CDM,270,RC,,,,,,,BOTH,,,1.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RECTAL TUBE 24FR,82893-9,CDM,270,RC,,,,,,,BOTH,,,1.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH ALLPURPOSE 12FR,82135-5,CDM,270,RC,,,,,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING TELFA 4X5,83164-4,CDM,270,RC,,,,,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING/TELFA 4X5,82997-8,CDM,270,RC,,,,,,,BOTH,,,1.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH STERILE ALL PUR,80038-3,CDM,270,RC,,,,,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAPE ADHESIVE 1/2 INCH,82437-5,CDM,270,RC,,,,,,,BOTH,,,2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING TEGADERM IV,83255-0,CDM,270,RC,,,,,,,BOTH,,,2.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARAFES FOAM DISP,860601-4,CDM,270,RC,,,,,,,BOTH,,,2.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT BASEBALL SM,83389-7,CDM,270,RC,,,,,,,BOTH,,,2.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCTION SWAB,83223-8,CDM,270,RC,,,,,,,BOTH,,,2.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT BASEBALL MED,83390-5,CDM,270,RC,,,,,,,BOTH,,,2.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE CONTROL 10ML,83100-8,CDM,270,RC,,,,,,,BOTH,,,2.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TONGUE SCRAPER,83291-5,CDM,270,RC,,,,,,,BOTH,,,2.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT BASEBALL LG,83391-3,CDM,270,RC,,,,,,,BOTH,,,2.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SCAPEL #10,82039-9,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SCAPEL #11,82040-7,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLADES SCAPEL #15,82041-5,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MINI SPIKE DISPENSING PIN,82945-7,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAP SMEAR KIT,82263-5,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RAZOR,82211-4,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIMEN COMMODE,80103-5,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPONGE, SOF-WICK DRN",80078-9,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE MEASURE, DISP. FOR USE TO MEASURE WOUNDS",82903-6,CDM,270,RC,,,,,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ADAPT URET,83059-6,CDM,270,RC,,,,,,,BOTH,,,2.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLIP NOTES LARGE,81979-7,CDM,270,RC,,,,,,,BOTH,,,2.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLIP NOTES PED,860658-4,CDM,270,RC,,,,,,,BOTH,,,2.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLIP NOTES SM/MED,860647-7,CDM,270,RC,,,,,,,BOTH,,,2.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLIP MOTES BARIATRIC,83286-5,CDM,270,RC,,,,,,,BOTH,,,2.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAINS PENROSE A/SZ,80059-9,CDM,270,RC,,,,,,,BOTH,,,2.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"COBAN BANDAGE, 1 INCH",82284-1,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTENSION SET,83295-6,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METAL EYE SHIELD,81919-3,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICRON FILTER,81940-9,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NON-ADHESIVE DRESSG,81907-8,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE 10CC NT RTN,80117-5,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE INSULIN W/NL,80121-7,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE TB W/NEEDLE,80120-9,CDM,270,RC,,,,,,,BOTH,,,2.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV EXTENSION SET 6.5,83346-7,CDM,270,RC,,,,,,,BOTH,,,2.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING HYDROGEL2X2,83066-1,CDM,270,RC,,,,,,,BOTH,,,2.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP SCAPEL BLADE,81915-1,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EAR WICKS,82904-4,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIP THERAPY,87879-3,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLIP NOTES XL,82852-5,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOPCOCK 3-WAY,82940-8,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TELFA DRESSING,80131-6,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINALS,860618-8,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
YANKAUR SUCTION TUBE,81933-4,CDM,270,RC,,,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANISTER SUCTION800C,83309-5,CDM,270,RC,,,,,,,BOTH,,,3.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ENDO 3.5,83210-5,CDM,270,RC,,,,,,,BOTH,,,3.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE FEEDING ENT,83405-1,CDM,270,RC,,,,,,,BOTH,,,3.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LS SECONDARY SET,83318-6,CDM,270,RC,,,,,,,BOTH,,,3.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE,82735-2,CDM,270,RC,,,,,,,BOTH,,,3.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INJECTION CAPS,81944-1,CDM,270,RC,,,,,,,BOTH,,,3.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIKE ADAPTER,82402-9,CDM,270,RC,,,,,,,BOTH,,,3.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZEROWET SUPERSHIELD,82931-7,CDM,270,RC,,,,,,,BOTH,,,3.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER INDUCER,81924-3,CDM,270,RC,,,,,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING OPSITE 4 3/4 X4,82791-5,CDM,270,RC,,,,,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING PRIMAPORE 11 3/4 X 4,82792-3,CDM,270,RC,,,,,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPINAL NEEDLE 18GA X 3 1/2,82943-2,CDM,270,RC,,,,,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, DERMICEL 1''",80126-6,CDM,270,RC,,,,,,,BOTH,,,3.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HANDWIPE SANI HANDS,83198-2,CDM,270,RC,,,,,,,BOTH,,,3.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING OPTIFOAM,83155-2,CDM,270,RC,,,,,,,BOTH,,,3.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLING ARM XSMALL,82807-9,CDM,270,RC,,,,,,,BOTH,,,3.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOWEL STERILE,80132-4,CDM,270,RC,,,,,,,BOTH,,,3.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BEAVER KNIFE #61,82562-0,CDM,270,RC,,,,,,,BOTH,,,3.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY CLAMP,82738-6,CDM,270,RC,,,,,,,BOTH,,,4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RAZOR DOUBLE EDGE,82212-2,CDM,270,RC,,,,,,,BOTH,,,4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SECURE,80007-8,CDM,270,RC,,,,,,,BOTH,,,4.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SPINAL 27 GAUGE X 3 1/2",82786-5,CDM,270,RC,,,,,,,BOTH,,,4.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMAPORE DRESSING,80927-7,CDM,270,RC,,,,,,,BOTH,,,4.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALEM SUMP DRAIN 16F,80060-7,CDM,270,RC,,,,,,,BOTH,,,4.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WATER TRAP DRLN ADLT,83264-2,CDM,270,RC,,,,,,,BOTH,,,4.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XEROFORM DRESSING GAUZE 5X9,82906-9,CDM,270,RC,,,,,,,BOTH,,,4.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BANATROL PLUS,83307-9,CDM,270,RC,,,,,,,BOTH,,,4.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING TEGADERM6X8,83005-9,CDM,270,RC,,,,,,,BOTH,,,4.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY ORAL 120MM,83363-2,CDM,270,RC,,,,,,,BOTH,,,4.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY PVC SOFT 18FR,82992-9,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY PVC SOFT 20FR,82993-7,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY PVC SOFT 24FR,82994-5,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY PVC SOFT 30FR,82995-2,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AUTO GUARD 24 GAUGE,82520-8,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING ADAP 3X16,83204-8,CDM,270,RC,,,,,,,BOTH,,,4.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP ADLT LNG,43230-2,CDM,270,RC,,,,,,,BOTH,,,4.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP ADLT LNG,83230-3,CDM,270,RC,,,,,,,BOTH,,,4.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNDERPADS-CHUXS,80186-0,CDM,270,RC,,,,,,,BOTH,,,4.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO TUBE 3.5,82985-3,CDM,270,RC,,,,,,,BOTH,,,4.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP CUFF ML ADULT SM,83370-7,CDM,270,RC,,,,,,,BOTH,,,4.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORHEXDINE CLOTHS,83344-2,CDM,270,RC,,,,,,,BOTH,,,4.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP LIGHT SHIELD,81909-4,CDM,270,RC,,,,,,,BOTH,,,4.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ELASTOPLAST 1 INCH,82404-5,CDM,270,RC,,,,,,,BOTH,,,4.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"LIGHT SHIELDS, DOUBLE",82011-8,CDM,270,RC,,,,,,,BOTH,,,4.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SECONDARY SET,83303-8,CDM,270,RC,,,,,,,BOTH,,,4.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEIZURE STICKS,80099-5,CDM,270,RC,,,,,,,BOTH,,,4.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING ADAP 5X9,83205-5,CDM,270,RC,,,,,,,BOTH,,,4.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING KNEE SM/LNG,83356-6,CDM,270,RC,,,,,,,BOTH,,,4.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-PORT,83248-5,CDM,270,RC,,,,,,,BOTH,,,4.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP CUFF ML ADULT,83369-9,CDM,270,RC,,,,,,,BOTH,,,4.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH INDUCER,81939-1,CDM,270,RC,,,,,,,BOTH,,,4.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSYTE IV CATHETER 20 GAUGE,82719-6,CDM,270,RC,,,,,,,BOTH,,,4.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPILEX DRESSING 3X3,82843-4,CDM,270,RC,,,,,,,BOTH,,,4.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCTION CATH KIT,80916-0,CDM,270,RC,,,,,,,BOTH,,,4.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WIPES BABY UNSCT,83245-1,CDM,270,RC,,,,,,,BOTH,,,4.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE SPINAL25X31/2,83077-8,CDM,270,RC,,,,,,,BOTH,,,4.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALVE LOPEZ ADULT,83011-7,CDM,270,RC,,,,,,,BOTH,,,4.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP ADULT,83227-9,CDM,270,RC,,,,,,,BOTH,,,4.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP SM ADULT,83228-7,CDM,270,RC,,,,,,,BOTH,,,4.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ELECTRODE PEDIATRIC,82216-3,CDM,270,RC,,,,,,,BOTH,,,5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTENSION SET W/3 WAY STOPCOCK,82344-3,CDM,270,RC,,,,,,,BOTH,,,5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SPINAL 18 GAUGE X 6",82785-7,CDM,270,RC,,,,,,,BOTH,,,5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SPINAL 22 GAUGE X 5",82787-3,CDM,270,RC,,,,,,,BOTH,,,5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SPINAL 27 GA X 4 1/2",82789-9,CDM,270,RC,,,,,,,BOTH,,,5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLING ARM MEDIUM,82226-2,CDM,270,RC,,,,,,,BOTH,,,5.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOWL STERILE 16OZ,83314-5,CDM,270,RC,,,,,,,BOTH,,,5.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 26FR 5CC,82003-5,CDM,270,RC,,,,,,,BOTH,,,5.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 28FR 5CC,82005-0,CDM,270,RC,,,,,,,BOTH,,,5.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SET SALINE TRANSFER,83080-2,CDM,270,RC,,,,,,,BOTH,,,5.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 16FR 5CC,82056-3,CDM,270,RC,,,,,,,BOTH,,,5.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEMALE URINAL,83341-8,CDM,270,RC,,,,,,,BOTH,,,5.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONOFILAMENT,82971-3,CDM,270,RC,,,,,,,BOTH,,,5.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STETHOSCOPE DISP,83074-5,CDM,270,RC,,,,,,,BOTH,,,5.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COBAN BANDAGE 3 INCH,82285-8,CDM,270,RC,,,,,,,BOTH,,,5.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE SPINAL22X31/2,83180-0,CDM,270,RC,,,,,,,BOTH,,,5.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE SPNL 20G 31/2,83140-4,CDM,270,RC,,,,,,,BOTH,,,5.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP NEEDLE COUNTER,81908-6,CDM,270,RC,,,,,,,BOTH,,,5.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTENSION SET,82394-8,CDM,270,RC,,,,,,,BOTH,,,5.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OINTMENT PROTECTIVE ALOE,82939-0,CDM,270,RC,,,,,,,BOTH,,,5.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLING ARM LARGE,82225-4,CDM,270,RC,,,,,,,BOTH,,,5.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TONSIL SPONGES, X LARGE",82413-6,CDM,270,RC,,,,,,,BOTH,,,5.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOTTLE PERI,80020-1,CDM,270,RC,,,,,,,BOTH,,,5.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAP SWAP LUER VALVE,83196-6,CDM,270,RC,,,,,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 18FR 30CC,81993-8,CDM,270,RC,,,,,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP LG ADULT,83229-5,CDM,270,RC,,,,,,,BOTH,,,6.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AUTO GUARD 18 GAUGE,82398-9,CDM,270,RC,,,,,,,BOTH,,,6.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AUTO GUARD 20 GAUGE,82397-1,CDM,270,RC,,,,,,,BOTH,,,6.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AUTO GUARD 22 GAUGE,82396-3,CDM,270,RC,,,,,,,BOTH,,,6.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SET KANGEROO JOEY,83047-1,CDM,270,RC,,,,,,,BOTH,,,6.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KANGEROO 924,83167-7,CDM,270,RC,,,,,,,BOTH,,,6.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGER COT,80352-8,CDM,270,RC,,,,,,,BOTH,,,6.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGER PROTECTOR 1 1/2,82067-0,CDM,270,RC,,,,,,,BOTH,,,6.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGER PROTECTOR 3,82068-8,CDM,270,RC,,,,,,,BOTH,,,6.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SILICONE 14FR,81991-2,CDM,270,RC,,,,,,,BOTH,,,6.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING OPTIFOAM AD,83226-1,CDM,270,RC,,,,,,,BOTH,,,6.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLING ARM SMALL,82224-7,CDM,270,RC,,,,,,,BOTH,,,6.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANGIOCATH 16 GAUGE,81950-8,CDM,270,RC,,,,,,,BOTH,,,6.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANGIOCATH 16GA X3.25,82808-7,CDM,270,RC,,,,,,,BOTH,,,6.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANGIOCATH 16GA X5.25,82806-1,CDM,270,RC,,,,,,,BOTH,,,6.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARBASOL CREAM,83179-2,CDM,270,RC,,,,,,,BOTH,,,6.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD SECONDARY SET,83293-1,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER TEXAS,80040-9,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN LINE STANDARD,83277-4,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUSLIN,80073-0,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPECULUM, DISP.",800105-9,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SYRINGE, LOR 7CC",82805-3,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAGINAL SPECULUM,810105-7,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VL NEEDLE ELECTRODE,82339-3,CDM,270,RC,,,,,,,BOTH,,,6.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP CUFF ML LG ADULT,83376-4,CDM,270,RC,,,,,,,BOTH,,,6.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY TRACH CARE,80162-1,CDM,270,RC,,,,,,,BOTH,,,6.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP L ADT LN,83231-1,CDM,270,RC,,,,,,,BOTH,,,6.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL SANITIZER,83343-4,CDM,270,RC,,,,,,,BOTH,,,6.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BEESWAX LIP BALM,83081-0,CDM,270,RC,,,,,,,BOTH,,,6.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINARY LEG BAG MED,83337-6,CDM,270,RC,,,,,,,BOTH,,,6.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COL SKIN BARRIER HOL,83114-9,CDM,270,RC,,,,,,,BOTH,,,6.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3 IN HONEYCOMB BDG,80936-8,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SILICONE 18 10,83342-6,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DURA PREP S APPLICAT,82384-9,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFANT ARM BOARD DIS,80956-6,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERI STRIP 1/2,82031-6,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERI STRIP 1/4,82030-8,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STERI STRIP 1/8,82029-0,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ULTIMATE BITE BLOCK,81934-2,CDM,270,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY 1PC POUCH,83377-2,CDM,270,RC,,,,,,,BOTH,,,7.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BITE BLOCK,80935-0,CDM,270,RC,,,,,,,BOTH,,,7.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 10 FR,82103-3,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 12 FR,82102-5,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 14 FR,82101-7,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 18 FR,82100-9,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 22 FR,82099-3,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 30 FR,82098-5,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER ALL PURPOSE 8FR,82104-1,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"DISP ARM BD, 9 X 3",81932-6,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EVACUATED BOTTLE 1000 ML,82810-3,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, DIAMOND POINT SPINAL",82768-3,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORTHOGLASS ALL SIZES PER FT,82844-2,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
READICAT,52059-3,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, UMBILICAL",80130-8,CDM,270,RC,,,,,,,BOTH,,,7.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 28FR 30CC,82004-3,CDM,270,RC,,,,,,,BOTH,,,7.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 30FR 30CC,82007-6,CDM,270,RC,,,,,,,BOTH,,,7.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EAR SYRINGES,80063-1,CDM,270,RC,,,,,,,BOTH,,,7.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFRA-RED LIGHT,960510-6,CDM,270,RC,,,,,,,BOTH,,,7.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PETROLATUM 1 X 36'',80069-8,CDM,270,RC,,,,,,,BOTH,,,7.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGS 35CC NT RTN,80118-3,CDM,270,RC,,,,,,,BOTH,,,7.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"VASELINE, TUBE",80071-4,CDM,270,RC,,,,,,,BOTH,,,7.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 22FR 30CC,81996-1,CDM,270,RC,,,,,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 24FR 5CC,82000-1,CDM,270,RC,,,,,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUR IRRIGATION SET,83386-3,CDM,270,RC,,,,,,,BOTH,,,7.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACE CONNECTOR ENTERA,83247-7,CDM,270,RC,,,,,,,BOTH,,,7.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANISTER SUCTION 1500ML,82956-4,CDM,270,RC,,,,,,,BOTH,,,7.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KANGEROO SETS,82873-1,CDM,270,RC,,,,,,,BOTH,,,7.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEDIATRIC ARM BD DIS,80957-4,CDM,270,RC,,,,,,,BOTH,,,7.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
X-RAY COVER,82532-3,CDM,270,RC,,,,,,,BOTH,,,7.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENEMA SET,80064-9,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VASELINE GAUZE 3 X 18,82188-4,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAUZE VASELINE 1/2 X 72,82189-2,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAUZE VASELINE 1 X 36,82190-0,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KIT INFANT CATH 5FR,82988-7,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPITEL MESH DRESSING,82842-6,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PETROLATUM 3 X 18'',80070-6,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VASELINE GAU 3X18,81070-5,CDM,270,RC,,,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKINGS KNEE XXL/L,83137-0,CDM,270,RC,,,,,,,BOTH,,,8.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKINGS KNEE XXL/R,83136-2,CDM,270,RC,,,,,,,BOTH,,,8.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 20FR 5CC,82058-9,CDM,270,RC,,,,,,,BOTH,,,8.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DR DRSG WHITE FOAM,83170-1,CDM,270,RC,,,,,,,BOTH,,,8.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 14FR 5CC,82633-9,CDM,270,RC,,,,,,,BOTH,,,8.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION SET 20GX1,83065-3,CDM,270,RC,,,,,,,BOTH,,,8.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH STABILIZING DEV,83272-5,CDM,270,RC,,,,,,,BOTH,,,8.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION SET 20X11/2,83070-3,CDM,270,RC,,,,,,,BOTH,,,8.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 12FR 5CC,81988-8,CDM,270,RC,,,,,,,BOTH,,,8.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADAPTER AIRWAY,83186-7,CDM,270,RC,,,,,,,BOTH,,,8.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 18FR 5CC,81992-0,CDM,270,RC,,,,,,,BOTH,,,8.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTIMA 18 GAUGE,82401-1,CDM,270,RC,,,,,,,BOTH,,,8.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTIMA 20 GAUGE,82399-7,CDM,270,RC,,,,,,,BOTH,,,8.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTIMA 22 GAUGE,82400-3,CDM,270,RC,,,,,,,BOTH,,,8.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 14FR 5CC,81990-4,CDM,270,RC,,,,,,,BOTH,,,8.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCENTED ODOR ELIM,83365-7,CDM,270,RC,,,,,,,BOTH,,,8.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SLING ARM XL,82616-4,CDM,270,RC,,,,,,,BOTH,,,8.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"INFUSION SET, 22 GA X 1",82797-2,CDM,270,RC,,,,,,,BOTH,,,8.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTIMIA 24GA X1,82909-3,CDM,270,RC,,,,,,,BOTH,,,8.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND CLEANSER,83242-8,CDM,270,RC,,,,,,,BOTH,,,8.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 20FR 5CC,81994-6,CDM,270,RC,,,,,,,BOTH,,,9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING;BIOCLUSIVE (OPSITE) 5X7,82878-0,CDM,270,RC,,,,,,,BOTH,,,9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGER/TOE SPLINT,80942-6,CDM,270,RC,,,,,,,BOTH,,,9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSFUSION SET,83322-8,CDM,270,RC,,,,,,,BOTH,,,9.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DSP THIGH,83232-9,CDM,270,RC,,,,,,,BOTH,,,9.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING BURN,83235-2,CDM,270,RC,,,,,,,BOTH,,,9.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 18FR 30CC,82749-3,CDM,270,RC,,,,,,,BOTH,,,9.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WIPES DRY 10X13 ATTD,83244-4,CDM,270,RC,,,,,,,BOTH,,,9.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDSTREAM CATCH KIT,80089-6,CDM,270,RC,,,,,,,BOTH,,,9.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMARY IV  SET,83321-0,CDM,270,RC,,,,,,,BOTH,,,9.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN LINE HIGH FLOW,83276-6,CDM,270,RC,,,,,,,BOTH,,,9.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
E-Z STABLIZER,83110-7,CDM,270,RC,,,,,,,BOTH,,,9.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
6.0 ENDO TUBE,82294-0,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
7.0 ENDO TUBE,82012-6,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
7.5 ENDO TUBE,82013-4,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
8.0 ENDO TUBE,82014-2,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
8.5 ENDO TUBE,82015-9,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
9.0 ENDO TUBE,82016-7,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EAKIN COHESIVE SEAL,82740-2,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDOMETRIAL PIPELLE,82926-7,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL CANNULA-MAC-SAFE,82928-3,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE TRACHEAL 4.0,82245-2,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE TRACHEAL 5.0,82246-0,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBE, ENDO DISP. 2.5",80179-5,CDM,270,RC,,,,,,,BOTH,,,9.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH FOLEY 30FR 5CC,82006-8,CDM,270,RC,,,,,,,BOTH,,,9.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 22FR 30CC,82745-1,CDM,270,RC,,,,,,,BOTH,,,9.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"DIAPERS, ADULT MEDIUM",82018-3,CDM,270,RC,,,,,,,BOTH,,,9.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHAVING CREAM TUBE,83290-7,CDM,270,RC,,,,,,,BOTH,,,9.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDIHONET 2X2 DRSG,83203-0,CDM,270,RC,,,,,,,BOTH,,,9.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY NASOPH 22FR,83218-8,CDM,270,RC,,,,,,,BOTH,,,9.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY NASOPH 26FR,83219-6,CDM,270,RC,,,,,,,BOTH,,,9.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALEM SUMP 16FRW/ARV,83361-6,CDM,270,RC,,,,,,,BOTH,,,9.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 8 FRENCH,82168-6,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 10 FR,81984-7,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 12 FR,81980-5,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 14 FR,81981-3,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 14-16 FR,81985-4,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUCTION 18 FR,81982-1,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUC 18 FR R,81983-9,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETERS SUCTION,80175-3,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INLINE BURETTE SET,83298-0,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MALE ADAPTER PLUG,80211-6,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCARLET RED,80077-1,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOMACH TUBE 12 FR,82242-9,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOMACH TUBE 14FR,82243-7,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOMACH TUBE 18FR,82244-5,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE STOMACH 16FR,82169-4,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBES, STOMACH",80177-9,CDM,270,RC,,,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOBLE VAC CANISTER,82430-0,CDM,270,RC,,,,,,,BOTH,,,10.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING AQUA 4X4 PL,82884-8,CDM,270,RC,,,,,,,BOTH,,,10.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLIPPER BLADE NEW,83375-6,CDM,270,RC,,,,,,,BOTH,,,10.37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADHESIVE MASTISOL L,83030-7,CDM,270,RC,,,,,,,BOTH,,,10.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MICROPORE TAPE, 2 INCH",82009-2,CDM,270,RC,,,,,,,BOTH,,,10.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICROPORE TAPE 3 INCH,82010-0,CDM,270,RC,,,,,,,BOTH,,,10.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLYMEN DRESSING 4X4,82972-1,CDM,270,RC,,,,,,,BOTH,,,10.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THERMOVENT 600,82414-4,CDM,270,RC,,,,,,,BOTH,,,10.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SILICONE 24 FR 5CC,82725-3,CDM,270,RC,,,,,,,BOTH,,,10.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FECAL COLLECTION BAG,83209-7,CDM,270,RC,,,,,,,BOTH,,,10.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP CUFF  ML ADULT LG,83371-5,CDM,270,RC,,,,,,,BOTH,,,10.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SILICON 26FR30C,82002-7,CDM,270,RC,,,,,,,BOTH,,,10.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 22FR 5CC,82105-8,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER, 3-WAY 18FR.30CC",82954-9,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEEDING SET PATROL,82887-1,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MALE ADAPTER PLUG,83299-8,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASOPHARYNEAL AIRWAY 14FR,82872-3,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"OINTMENT, ANTIFUNGAL ALOE",82937-4,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHILEY TRACH TUBE HOLDER,82905-1,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, DERMICEL 3''",80127-4,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, MEDAPORE 2 INCH",82634-7,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENILOOP,83304-6,CDM,270,RC,,,,,,,BOTH,,,10.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 22FR,82132-2,CDM,270,RC,,,,,,,BOTH,,,10.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHORHEXIDINE CLOTH 6,83380-6,CDM,270,RC,,,,,,,BOTH,,,10.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE SPINAL 20GX5,83158-6,CDM,270,RC,,,,,,,BOTH,,,11.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDIHONEY JELL,83200-6,CDM,270,RC,,,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 6 FR PEDIATRIC,82818-6,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLON,80168-8,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP. ADULT ARM BD.,81920-1,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOF-ROL TO REF. CAST,80327-0,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STYRO POF ALL SIZES,80366-8,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSPORE TAPE,80213-2,CDM,270,RC,,,,,,,BOTH,,,11.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECLOGGER BLUE 12-14,83091-9,CDM,270,RC,,,,,,,BOTH,,,11.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECLOGGER ORGE 18-24,83092-7,CDM,270,RC,,,,,,,BOTH,,,11.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 3.0",82595-0,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 4.0",82596-8,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 4.5",82597-6,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 6.0",82598-4,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGERSPLINT STACKS,82630-5,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLES SPINAL EXTRA,10427-3,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYRINGE 60CC NT RTN,80119-1,CDM,270,RC,,,,,,,BOTH,,,11.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOLDER LEG BAND,83364-0,CDM,270,RC,,,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KERLEX,810015-8,CDM,270,RC,,,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"KERLIX 4 BANDAGE""",82185-0,CDM,270,RC,,,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PETROLATUM 1/2 X 72',80068-0,CDM,270,RC,,,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSODYNE TOOTHPASTE,83406-9,CDM,270,RC,,,,,,,BOTH,,,12.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALEM SUMP DRAIN 10F,83143-8,CDM,270,RC,,,,,,,BOTH,,,12.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALEM SUMP DRAIN 14F,83144-6,CDM,270,RC,,,,,,,BOTH,,,12.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALEM SUMP DRAIN 18F,83145-3,CDM,270,RC,,,,,,,BOTH,,,12.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENI LOOP NEW,83378-0,CDM,270,RC,,,,,,,BOTH,,,12.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAG BALM,83206-3,CDM,270,RC,,,,,,,BOTH,,,12.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DR Y CONNECTORS,83172-7,CDM,270,RC,,,,,,,BOTH,,,12.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO TUBE 3.5,82892-1,CDM,270,RC,,,,,,,BOTH,,,12.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE COLLECTOR 24HR,80184-5,CDM,270,RC,,,,,,,BOTH,,,12.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 20FR 30CC,82059-7,CDM,270,RC,,,,,,,BOTH,,,12.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE SPINAL 20GX7,83159-4,CDM,270,RC,,,,,,,BOTH,,,12.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 1/4,82150-4,CDM,270,RC,,,,,,,BOTH,,,12.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECLOGGER 16/18FR YE,83176-8,CDM,270,RC,,,,,,,BOTH,,,12.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER,THORACIC 16FR",82991-1,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER,THORACIC 24FR",82990-3,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEMALE CATH KIT,80933-5,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAX FINGER SPLINT,82425-0,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICAL CLIPPER BL,81911-0,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, MONTG. STRAPS",80129-0,CDM,270,RC,,,,,,,BOTH,,,12.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MR BP CUFF CHILD,83328-5,CDM,270,RC,,,,,,,BOTH,,,12.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRODUCER ADULT 15F,83190-9,CDM,270,RC,,,,,,,BOTH,,,12.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLEVYN DRESSING 3X3,82946-5,CDM,270,RC,,,,,,,BOTH,,,12.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM/SODIUM ALG,82882-2,CDM,270,RC,,,,,,,BOTH,,,12.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN SALEM SUMP 12F,83134-7,CDM,270,RC,,,,,,,BOTH,,,12.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABDOMINAL BINDER LG,83381-4,CDM,270,RC,,,,,,,BOTH,,,12.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 5.5",82602-4,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, HARD 8.5",82601-6,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO TUBE, SOFT 6.5",82594-3,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENWALL BLOOD SET,82608-1,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INCONT BRIEFS ATTDS,80343-7,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KANGEROO SET DUAL,83174-3,CDM,270,RC,,,,,,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 24FR 30CC,82750-1,CDM,270,RC,,,,,,,BOTH,,,13.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DISP ML XL,83404-4,CDM,270,RC,,,,,,,BOTH,,,13.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITRO PLUMSET IVSET,83319-4,CDM,270,RC,,,,,,,BOTH,,,13.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
X-L DIAPER,82854-1,CDM,270,RC,,,,,,,BOTH,,,13.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALINE WET DRESSING,80925-1,CDM,270,RC,,,,,,,BOTH,,,13.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERI WASH,80097-9,CDM,270,RC,,,,,,,BOTH,,,13.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROBE ESOPH RECT,83195-8,CDM,270,RC,,,,,,,BOTH,,,13.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DI S ADLT MR,83251-9,CDM,270,RC,,,,,,,BOTH,,,13.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CORN PAD,87876-9,CDM,270,RC,,,,,,,BOTH,,,13.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CVC DRESSING TRAY,82912-7,CDM,270,RC,,,,,,,BOTH,,,13.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DENTURE ADHESIVE,82886-3,CDM,270,RC,,,,,,,BOTH,,,13.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRIEF MESH XXXL,83153-7,CDM,270,RC,,,,,,,BOTH,,,13.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MULT-PUNCTIONAL PORT,83312-9,CDM,270,RC,,,,,,,BOTH,,,13.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE WOMEN SMALL,82970-5,CDM,270,RC,,,,,,,BOTH,,,13.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EVACUATOR BULB 100CC,83083-6,CDM,270,RC,,,,,,,BOTH,,,13.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUCAS TRAP,80208-2,CDM,270,RC,,,,,,,BOTH,,,13.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PACKING IODOFORM 1/2,82154-6,CDM,270,RC,,,,,,,BOTH,,,13.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PACKING IODOFORM 1/4,82155-3,CDM,270,RC,,,,,,,BOTH,,,13.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, MICROPORE",80125-8,CDM,270,RC,,,,,,,BOTH,,,13.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOOMEY SYRINGE,80223-1,CDM,270,RC,,,,,,,BOTH,,,13.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOURNT-COT SMALL,83366-5,CDM,270,RC,,,,,,,BOTH,,,13.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARE PADS SHEEPSKIN,80024-3,CDM,270,RC,,,,,,,BOTH,,,13.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOURNI-COT,82585-1,CDM,270,RC,,,,,,,BOTH,,,13.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BREATHE RIGHT STRIPS,82950-7,CDM,270,RC,,,,,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BODY BAG ADULT,82948-1,CDM,270,RC,,,,,,,BOTH,,,14.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAVILOR BARRIER CR,83184-2,CDM,270,RC,,,,,,,BOTH,,,14.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST-OP SHOE W X-SM,83031-5,CDM,270,RC,,,,,,,BOTH,,,14.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING BIATAIN 4X4,83308-7,CDM,270,RC,,,,,,,BOTH,,,14.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
10 FRENCH STYLET,82429-2,CDM,270,RC,,,,,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GELFOAM SIZE 7MM,82855-8,CDM,270,RC,,,,,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NAPKINS, SANITARY",80090-4,CDM,270,RC,,,,,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STYLET 10 FRENCH,82423-5,CDM,270,RC,,,,,,,BOTH,,,14.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DI ADULT MR,83278-2,CDM,270,RC,,,,,,,BOTH,,,14.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TECHNI-CARE SURGICAL SCRUB,82965-5,CDM,270,RC,,,,,,,BOTH,,,14.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY LARYNGEAL 2,83367-3,CDM,270,RC,,,,,,,BOTH,,,14.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMARY/FILTER SET,83320-2,CDM,270,RC,,,,,,,BOTH,,,14.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"4 TROCAR K-WIRE""",82465-6,CDM,270,RC,,,,,,,BOTH,,,15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STYLET 6.5,82306-2,CDM,270,RC,,,,,,,BOTH,,,15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STYLET 8.5,80938-4,CDM,270,RC,,,,,,,BOTH,,,15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DETANGLER,83266-7,CDM,270,RC,,,,,,,BOTH,,,15.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY LARYNGEAL 2.5,83368-1,CDM,270,RC,,,,,,,BOTH,,,15.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BREATHING CIRCUITS/PEDIATRIC,82346-8,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BURN PACK, DISP.",10444-8,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH GUIDE-SOUND,80034-2,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAPERS,82415-1,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP BURN PK CLINIC,11444-7,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISTILLED WATER,80057-3,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV CATHETER PLUG,80922-8,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENROSE DRAIN 1/4,82096-9,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POISE PADS,82385-6,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREP KIT SURG HAND,10435-6,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINARY IRRIG. SET,80182-9,CDM,270,RC,,,,,,,BOTH,,,15.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HME XTRAFLOW LARYN,83268-3,CDM,270,RC,,,,,,,BOTH,,,15.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING COLLASEN HY,83249-3,CDM,270,RC,,,,,,,BOTH,,,15.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROPHIL DRESS 8X8,83330-1,CDM,270,RC,,,,,,,BOTH,,,15.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 24FR 30CC,82744-4,CDM,270,RC,,,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASK LMA SIZE 3,83215-4,CDM,270,RC,,,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STETH ESOPH/TEMP 18F,83094-3,CDM,270,RC,,,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSDUCER COVER,83006-7,CDM,270,RC,,,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE GASTRIC LAV 36F,83004-2,CDM,270,RC,,,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
G-TUBE SECURE DEVICE,83280-8,CDM,270,RC,,,,,,,BOTH,,,15.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIR HOSE DISP,83259-2,CDM,270,RC,,,,,,,BOTH,,,15.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PASTE,80052-4,CDM,270,RC,,,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV. SOLUTION CONT.,80221-5,CDM,270,RC,,,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENOCATH,80206-6,CDM,270,RC,,,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STATLOCK STBL DEVICE,83138-8,CDM,270,RC,,,,,,,BOTH,,,16.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN FLAT HUBLESS,83085-1,CDM,270,RC,,,,,,,BOTH,,,16.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING HYDRO BLUE,83257-6,CDM,270,RC,,,,,,,BOTH,,,16.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING 10FR,83216-2,CDM,270,RC,,,,,,,BOTH,,,16.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE MEN-SMALL,82923-4,CDM,270,RC,,,,,,,BOTH,,,16.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE ROUTINE,80108-4,CDM,270,RC,,,,,,,BOTH,,,16.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UROGATE IRRIG. SET,80187-8,CDM,270,RC,,,,,,,BOTH,,,16.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMARY SET 3CLAVE,83292-3,CDM,270,RC,,,,,,,BOTH,,,16.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING BIATAIN 4X4,82859-0,CDM,270,RC,,,,,,,BOTH,,,16.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACCU-DISC SYRINGE,82815-2,CDM,270,RC,,,,,,,BOTH,,,16.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING MEPILEX,83062-0,CDM,270,RC,,,,,,,BOTH,,,16.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRODUCER PED 10FR,83189-1,CDM,270,RC,,,,,,,BOTH,,,16.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIMB HOLDER,80934-3,CDM,270,RC,,,,,,,BOTH,,,16.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PENS, SKIN MARKING",10430-7,CDM,270,RC,,,,,,,BOTH,,,16.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DI ADLT L MR,83252-7,CDM,270,RC,,,,,,,BOTH,,,16.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3-WAY STOPCOCK,80914-5,CDM,270,RC,,,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DURA PREP L APPLICAT,82383-1,CDM,270,RC,,,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REINFORCING STRIPS,82564-6,CDM,270,RC,,,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION PWRL 20X1.5,83353-3,CDM,270,RC,,,,,,,BOTH,,,17.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION PWRL 22X1.5,83354-1,CDM,270,RC,,,,,,,BOTH,,,17.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVER FULLBODY P/OP,83394-7,CDM,270,RC,,,,,,,BOTH,,,17.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SAMPLING LINE ADULT,83187-5,CDM,270,RC,,,,,,,BOTH,,,17.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DI L ADLT MR,83279-0,CDM,270,RC,,,,,,,BOTH,,,17.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANNULA ADLT DIVIDED,83093-5,CDM,270,RC,,,,,,,BOTH,,,17.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORA PREP,83072-9,CDM,270,RC,,,,,,,BOTH,,,17.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DR DERMANET AG,83171-9,CDM,270,RC,,,,,,,BOTH,,,17.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOLEY CATHETER TRAY,82704-8,CDM,270,RC,,,,,,,BOTH,,,17.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNDERPAD PREMIUM,83265-9,CDM,270,RC,,,,,,,BOTH,,,17.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H20 TRAP,60089-0,CDM,270,RC,,,,,,,BOTH,,,17.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICAL NAIL REMOVAL KIT,82804-6,CDM,270,RC,,,,,,,BOTH,,,17.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY NASO 7MM,83029-9,CDM,270,RC,,,,,,,BOTH,,,17.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING BIATAIN 5X5,82862-4,CDM,270,RC,,,,,,,BOTH,,,17.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING MEPITEL,83121-4,CDM,270,RC,,,,,,,BOTH,,,17.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY  POWDER,83118-0,CDM,270,RC,,,,,,,BOTH,,,17.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SKIN TEMP PROBE INF,83401-0,CDM,270,RC,,,,,,,BOTH,,,17.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER PLUGS,80036-7,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLY-Q-PACK,80194-4,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV START PACK,80199-3,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K-WIRE W/TROCAR .035 X 9 INCH,82380-7,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING 5 FR,82164-5,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING 8FR,82165-2,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING 8FR 42 LENGTH,82166-0,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBE, FEEDING, AL/SZ",80172-0,CDM,270,RC,,,,,,,BOTH,,,17.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEG LIFTER RIDIG,83157-8,CDM,270,RC,,,,,,,BOTH,,,18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POWERLOC NDL 20GX7.5,83347-5,CDM,270,RC,,,,,,,BOTH,,,18.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRSG ALLEVYN SACRUM,83106-5,CDM,270,RC,,,,,,,BOTH,,,18.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUL-T-PAD,82412-8,CDM,270,RC,,,,,,,BOTH,,,18.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING REGULAR THIGH. XL,82847-5,CDM,270,RC,,,,,,,BOTH,,,18.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISPOSABLE SUCTION BOTTLE,82389-8,CDM,270,RC,,,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OP-SITE DRESSING,80067-2,CDM,270,RC,,,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING SETS,80133-2,CDM,270,RC,,,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URIMETER,80185-2,CDM,270,RC,,,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
YANKAUR SUCTION TUBE,80189-4,CDM,270,RC,,,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INCLINE BURRETTE SET,83317-8,CDM,270,RC,,,,,,,BOTH,,,18.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CO2 NASAL CANNULA,83181-8,CDM,270,RC,,,,,,,BOTH,,,18.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
G TUBE SECURE MED,83383-0,CDM,270,RC,,,,,,,BOTH,,,18.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 3/4,83254-3,CDM,270,RC,,,,,,,BOTH,,,18.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BIOPATCH 1 4MM CTR""",83243-6,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY A/SZ,80032-6,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NG-STRIP,NASAL TUBE",801233-8,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QED ALCOHOL TEST,81917-7,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SHOE, POST-OP",82763-4,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUPRAMID SUTURE,82746-9,CDM,270,RC,,,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BEAVER KNIFE #69,82561-2,CDM,270,RC,,,,,,,BOTH,,,19.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTENSION W/FILTER,83296-4,CDM,270,RC,,,,,,,BOTH,,,19.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUFF BP DI L ADLT MR,83253-5,CDM,270,RC,,,,,,,BOTH,,,19.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CTA NEEDLE,83327-7,CDM,270,RC,,,,,,,BOTH,,,19.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 1/4,82637-0,CDM,270,RC,,,,,,,BOTH,,,19.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUIDE WIRE 100MM,82871-5,CDM,270,RC,,,,,,,BOTH,,,19.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PASTE ILEX SKIN PROT,83154-5,CDM,270,RC,,,,,,,BOTH,,,19.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, EYE IRRIG.",80148-0,CDM,270,RC,,,,,,,BOTH,,,19.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBING, CONDUCTIVE",80170-4,CDM,270,RC,,,,,,,BOTH,,,19.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING ALLEVYN 7X7,83036-4,CDM,270,RC,,,,,,,BOTH,,,19.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING MEPILEX 6X6,83078-6,CDM,270,RC,,,,,,,BOTH,,,19.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH 3-WAY 22FR,80228-0,CDM,270,RC,,,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AVEENO LOTION,83315-2,CDM,270,RC,,,,,,,BOTH,,,20.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INQ GUIDE WIRE .038,83332-7,CDM,270,RC,,,,,,,BOTH,,,20.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAPER ADULT XXLG,83043-0,CDM,270,RC,,,,,,,BOTH,,,20.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOPLAST STRIP PASTE,82978-8,CDM,270,RC,,,,,,,BOTH,,,20.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAINAGE BAGS URINAR,80062-3,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMPERVIOUS STOCKINETE,82351-8,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASOPHARYNGEOL AIRWAY,82347-6,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE LG MEN,82279-1,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE MED WOMEN,82276-7,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE MED MEN,82278-3,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP SHOE WOMEN LG,82277-5,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHILEY DISP INNER CANNULA 6.0MM,82897-0,CDM,270,RC,,,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND CLOSURE LG,83373-1,CDM,270,RC,,,,,,,BOTH,,,20.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND CLOSURE MED,83372-3,CDM,270,RC,,,,,,,BOTH,,,20.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ENDO, CHUCK-IT",80225-6,CDM,270,RC,,,,,,,BOTH,,,20.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GRAVITY TUBE SETS,80122-5,CDM,270,RC,,,,,,,BOTH,,,20.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SORBSAN WOUND DRESSING,82017-5,CDM,270,RC,,,,,,,BOTH,,,20.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUSPENSORY XL,82446-6,CDM,270,RC,,,,,,,BOTH,,,20.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBE, CONNECTING",80169-6,CDM,270,RC,,,,,,,BOTH,,,20.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENTERAL PUMP SET,81906-0,CDM,270,RC,,,,,,,BOTH,,,21.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LARYNGEAL MASK 1.0,82982-0,CDM,270,RC,,,,,,,BOTH,,,21.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LARYNGEAL MASK 1.5,82986-1,CDM,270,RC,,,,,,,BOTH,,,21.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LARYNGEAL MASK 2.5,82984-6,CDM,270,RC,,,,,,,BOTH,,,21.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRODUCER-80UGIETGO,83350-9,CDM,270,RC,,,,,,,BOTH,,,21.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, PREP, DISP.",80155-5,CDM,270,RC,,,,,,,BOTH,,,21.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING MEPLIX HEEL,83185-9,CDM,270,RC,,,,,,,BOTH,,,21.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMOGRAN PRISMA DRG,83331-9,CDM,270,RC,,,,,,,BOTH,,,21.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
O2 CYLINDER  (SBY),80447-6,CDM,270,RC,,,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER, 3-WAY 16FR.5CC",82975-4,CDM,270,RC,,,,,,,BOTH,,,22.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 3/4,83250-1,CDM,270,RC,,,,,,,BOTH,,,22.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEETH GUARD,80450-0,CDM,270,RC,,,,,,,BOTH,,,22.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VASELINE CREAM,83192-5,CDM,270,RC,,,,,,,BOTH,,,22.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAINAGE BOTTLE NS,83275-8,CDM,270,RC,,,,,,,BOTH,,,22.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSI-CARE LOTION 4OZ,82922-6,CDM,270,RC,,,,,,,BOTH,,,22.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL RHINO ROCKET S,83177-6,CDM,270,RC,,,,,,,BOTH,,,22.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUT DOWN CAST,80923-6,CDM,270,RC,,,,,,,BOTH,,,22.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SAMPLING LINE A/P ET,83285-7,CDM,270,RC,,,,,,,BOTH,,,22.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD CASSETTE,82883-0,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE L XLONG,82534-9,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"INTERCATH, ALL SIZE",80198-5,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL FORCEPS & SPEC,80151-4,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SNAKEBITE KIT,80102-7,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCTION MACHINE,960519-7,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE DACRON 2,80109-2,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THORACENTESIS SET,82770-9,CDM,270,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRSG MEDI HONEY 4.3,83208-9,CDM,270,RC,,,,,,,BOTH,,,23.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PULL-UPS ADULT XXL,83060-4,CDM,270,RC,,,,,,,BOTH,,,23.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOCIE HANDLE CLINIC,11415-7,CDM,270,RC,,,,,,,BOTH,,,23.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HANDLE (BOVIE),10415-8,CDM,270,RC,,,,,,,BOTH,,,23.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K WIRE BALLS,82506-7,CDM,270,RC,,,,,,,BOTH,,,23.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEDIATRIC ENDO TUBE,81916-9,CDM,270,RC,,,,,,,BOTH,,,23.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIBIOTIC POWDER,83382-2,CDM,270,RC,,,,,,,BOTH,,,23.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INF POWERLOC 20GX.75,83326-9,CDM,270,RC,,,,,,,BOTH,,,23.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCTION BELL W/ADH,83236-0,CDM,270,RC,,,,,,,BOTH,,,23.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EASY CAP C02 MONITOR,82723-8,CDM,270,RC,,,,,,,BOTH,,,23.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO TUBE 5.5,82445-8,CDM,270,RC,,,,,,,BOTH,,,23.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LARYSEAL MASKAIRWAY,83310-3,CDM,270,RC,,,,,,,BOTH,,,23.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY CENTRAL LINE,83256-8,CDM,270,RC,,,,,,,BOTH,,,23.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AVEENO BODYWASH,83316-0,CDM,270,RC,,,,,,,BOTH,,,23.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGIFOAM ABSRB 12-7,83281-6,CDM,270,RC,,,,,,,BOTH,,,23.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SKIN BARRIER WIPE,83403-6,CDM,270,RC,,,,,,,BOTH,,,24.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAG NEPHROSTOMY,83041-4,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE LARGE/REGULAR,81965-6,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE MEDIUM/LONG,81964-9,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE MEDIUM/REGULAR,81963-1,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE SMALL/REGULAR,81962-3,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE X-LARGE/LONG,81966-4,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"HOSE KNEE, LRG LG",82386-4,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE-HI X LG,82318-7,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH X-LARGE/LONG,819755-0,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARACENTESIS SET UP,82304-7,CDM,270,RC,,,,,,,BOTH,,,24.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC WHITEFOAM DRSY,83042-2,CDM,270,RC,,,,,,,BOTH,,,24.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI REFLUX FILTER,83407-7,CDM,270,RC,,,,,,,BOTH,,,24.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER COUDE, 16FR",82821-0,CDM,270,RC,,,,,,,BOTH,,,24.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TAPE ADHESIVE AL/SZ,80124-1,CDM,270,RC,,,,,,,BOTH,,,24.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 20,83217-0,CDM,270,RC,,,,,,,BOTH,,,24.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASK LMA SIZE 2,83213-9,CDM,270,RC,,,,,,,BOTH,,,24.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, EPIDURAL 16GA X 3.5",82753-5,CDM,270,RC,,,,,,,BOTH,,,25.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHGRIP DEVICE,83339-2,CDM,270,RC,,,,,,,BOTH,,,25.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY NASOPH 8.0MM,83151-1,CDM,270,RC,,,,,,,BOTH,,,25.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASK LMA SIZE 1.5,83212-1,CDM,270,RC,,,,,,,BOTH,,,25.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASK LMA SIZE 2.5,83214-7,CDM,270,RC,,,,,,,BOTH,,,25.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASK LMA SIZE 1,83211-3,CDM,270,RC,,,,,,,BOTH,,,25.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEEL PROTECTORS,80085-4,CDM,270,RC,,,,,,,BOTH,,,25.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY IGEL 4,83392-1,CDM,270,RC,,,,,,,BOTH,,,25.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY IGEL 5,83393-9,CDM,270,RC,,,,,,,BOTH,,,25.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING AQUACEL 4X4,82861-6,CDM,270,RC,,,,,,,BOTH,,,25.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY I GEL 1.0,83388-9,CDM,270,RC,,,,,,,BOTH,,,25.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY I GEL 1.5,83387-1,CDM,270,RC,,,,,,,BOTH,,,25.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAL A FLO SET,83294-9,CDM,270,RC,,,,,,,BOTH,,,26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETCO2 CABLE,83161-0,CDM,270,RC,,,,,,,BOTH,,,26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MASIMO PED SPO2 SEN,83329-3,CDM,270,RC,,,,,,,BOTH,,,26.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI-VALVE,81942-5,CDM,270,RC,,,,,,,BOTH,,,26.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAYFIX FIXATION DEV,83037-2,CDM,270,RC,,,,,,,BOTH,,,26.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO-TUBE HOLDER,80940-0,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMP STOCKINETTE (LG),82486-2,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION SET,80905-3,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PULL UPS ADULT/LARGE,82962-2,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT THUMB UNIVERAL,82305-4,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
Y-CONNECTOR (KCI),82953-1,CDM,270,RC,,,,,,,BOTH,,,26.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BEDPAN FR BARIATRIC,83173-5,CDM,270,RC,,,,,,,BOTH,,,26.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING MEPILEX AG,83152-9,CDM,270,RC,,,,,,,BOTH,,,26.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP A BAG,80058-1,CDM,270,RC,,,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"RESTON, PADDING",80098-7,CDM,270,RC,,,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAPER ADULT XXXL,83400-2,CDM,270,RC,,,,,,,BOTH,,,27.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"FELT, ORTHO 1/4''",80335-3,CDM,270,RC,,,,,,,BOTH,,,27.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTERNAL URINE DEVIC,83359-0,CDM,270,RC,,,,,,,BOTH,,,27.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STATLOCK DEVICE10-12,83336-8,CDM,270,RC,,,,,,,BOTH,,,27.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BANDSGE SURE PRESS,83099-2,CDM,270,RC,,,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"LEG BAG, DISP.",80216-5,CDM,270,RC,,,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 10FR,83126-3,CDM,270,RC,,,,,,,BOTH,,,28.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 12FR,83127-1,CDM,270,RC,,,,,,,BOTH,,,28.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE ECHOTIP 21G7C,83018-2,CDM,270,RC,,,,,,,BOTH,,,28.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY BIOPSY MAMMO,83012-5,CDM,270,RC,,,,,,,BOTH,,,28.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOBBHOFF TUBE 12FR,82952-3,CDM,270,RC,,,,,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DUO-DERM DRESSING,80054-0,CDM,270,RC,,,,,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAND SPLINT ORTHOGLASS,82727-9,CDM,270,RC,,,,,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCA PUMP SET,801231-2,CDM,270,RC,,,35590300000,NDC,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHORT LEG PLASTER SPLINT,82363-3,CDM,270,RC,,,,,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHORT ARM PLASTER SPLINT,82334-4,CDM,270,RC,,,,,,,BOTH,,,28.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SET SAVER FILTER,80222-3,CDM,270,RC,,,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STIMULEN COLLGN PWDR,83234-5,CDM,270,RC,,,,,,,BOTH,,,29.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLANKET MAX-THERM,83194-1,CDM,270,RC,,,,,,,BOTH,,,29.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL RHINO ROCKET M,83178-4,CDM,270,RC,,,,,,,BOTH,,,29.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAY SUTURE NYLON 2,80111-8,CDM,270,RC,,,,,,,BOTH,,,29.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING BAR XXLG,83096-8,CDM,270,RC,,,,,,,BOTH,,,29.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING BAR XXLG RG,83095-0,CDM,270,RC,,,,,,,BOTH,,,29.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDIHONEY GEL 1.5 OZ,83260-0,CDM,270,RC,,,,,,,BOTH,,,29.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CO2 SAMPLE TUBING,82918-4,CDM,270,RC,,,,,,,BOTH,,,29.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ASPIRATING,80165-4,CDM,270,RC,,,,,,,BOTH,,,29.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALOE VESTA CLEANSING,82977-0,CDM,270,RC,,,,,,,BOTH,,,30.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SAMPLING LINE NASAL,83287-3,CDM,270,RC,,,,,,,BOTH,,,30.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVELING MATTRESSES,80026-8,CDM,270,RC,,,,,,,BOTH,,,30.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONITOR PAD GREEN,960515-5,CDM,270,RC,,,,,,,BOTH,,,30.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE INTRAOSSEOUS 15 GA,82824-4,CDM,270,RC,,,,,,,BOTH,,,30.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE INTRAOSSEOUS 18,822023-8,CDM,270,RC,,,,,,,BOTH,,,30.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEAT CRADLE,960509-8,CDM,270,RC,,,,,,,BOTH,,,30.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PACKING PLAIN 1/4,82160-3,CDM,270,RC,,,,,,,BOTH,,,30.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLAIN PACKING AL/SIZ,80072-2,CDM,270,RC,,,,,,,BOTH,,,30.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 14FR,83128-9,CDM,270,RC,,,,,,,BOTH,,,30.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 16FR,83129-7,CDM,270,RC,,,,,,,BOTH,,,30.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 18FR,83130-5,CDM,270,RC,,,,,,,BOTH,,,30.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 8FR,83125-5,CDM,270,RC,,,,,,,BOTH,,,30.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CATHETER SILICONE 12 FRENCH, 5CC",82320-3,CDM,270,RC,,,,,,,BOTH,,,31.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SILICONE 14 FRENCH 30CC,82381-5,CDM,270,RC,,,,,,,BOTH,,,31.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COUDE CATHETER 16 FRENCH,82309-6,CDM,270,RC,,,,,,,BOTH,,,31.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COUDE CATHETER 18 FRENCH,82310-4,CDM,270,RC,,,,,,,BOTH,,,31.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"HEEL PROTECTORS, POSEY",82732-9,CDM,270,RC,,,,,,,BOTH,,,31.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNDERPAD XXLG,83379-8,CDM,270,RC,,,,,,,BOTH,,,31.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION POWERLOC,83188-3,CDM,270,RC,,,,,,,BOTH,,,31.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLLECTION BOTTLE,80380-9,CDM,270,RC,,,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE SILK 4-0,80113-4,CDM,270,RC,,,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEONAT AD SP02 SENSR,83325-1,CDM,270,RC,,,,,,,BOTH,,,32.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSOR INFANT SP02,83355-8,CDM,270,RC,,,,,,,BOTH,,,32.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNNA BOOT/JELL CAST 3 INCH,82289-0,CDM,270,RC,,,,,,,BOTH,,,32.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNNA BOOT/JELL CAST 4 INCH,82291-6,CDM,270,RC,,,,,,,BOTH,,,32.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLLAGEN POWDER,83348-3,CDM,270,RC,,,,,,,BOTH,,,32.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SAW BLADE 9.7 X 20.8MM,82387-2,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SAW BLADE MICRO SAGITTAL 4.5 X 25.5,82376-5,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SAW BLADE, OSCILLATING 5.8 X 11.4",82375-7,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SAW BLADE, MICRO SAGITTAL 9.4 MM X 25.5 MM",82374-0,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SAW BLADE, OSCILLATING 5.8 MM X 18.5",82371-6,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SAW BLADE, OSCILLATING 5.8 MM X 28.2",82373-2,CDM,270,RC,,,,,,,BOTH,,,32.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSETHIGH HI LGSHORT,82627-1,CDM,270,RC,,,,,,,BOTH,,,33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPINAL NEEDLE, QUINCKE 25 GA X 7",82812-9,CDM,270,RC,,,,,,,BOTH,,,33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPINAL NEEDLE, QUINCKE 25 GA X 8",82813-7,CDM,270,RC,,,,,,,BOTH,,,33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 16 FR 5CC,82635-4,CDM,270,RC,,,,,,,BOTH,,,33.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 18FR 5CC,82636-2,CDM,270,RC,,,,,,,BOTH,,,33.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEEL/ELBOW CUSHION,82724-6,CDM,270,RC,,,,,,,BOTH,,,33.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"T-TUBES, ALL SIZES",80180-3,CDM,270,RC,,,,,,,BOTH,,,33.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY LUMBAR ADULT,80912-9,CDM,270,RC,,,,,,,BOTH,,,33.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALARM CHAIR SENSOR,83399-6,CDM,270,RC,,,,,,,BOTH,,,33.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WIPES,83117-2,CDM,270,RC,,,,,,,BOTH,,,34.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"INFUSION SET, 20 GAUGE",82708-9,CDM,270,RC,,,,,,,BOTH,,,34.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMOGRAN DRESSING,82944-0,CDM,270,RC,,,,,,,BOTH,,,34.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ANDERSON 10,80164-7,CDM,270,RC,,,,,,,BOTH,,,34.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER TROCAR 32 FRENCH,82820-2,CDM,270,RC,,,,,,,BOTH,,,34.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL RHINO ROCKET L,80921-0,CDM,270,RC,,,,,,,BOTH,,,34.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAD GROUNDING DISP,10429-9,CDM,270,RC,,,,,,,BOTH,,,34.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, MOLESKIN AL/SZ",80128-2,CDM,270,RC,,,,,,,BOTH,,,34.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, ADD-A-FOLEY",80138-1,CDM,270,RC,,,,,,,BOTH,,,34.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPIDURAL MINI KIT,82733-7,CDM,270,RC,,,,,,,BOTH,,,34.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARRIER SENSI-CARE 4,82938-2,CDM,270,RC,,,,,,,BOTH,,,35.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEAD WIRE 5 ECG DISP,83288-1,CDM,270,RC,,,,,,,BOTH,,,35.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEEDING INT 12F,83024-0,CDM,270,RC,,,,,,,BOTH,,,35.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE AIR-LON TRACH,80941-8,CDM,270,RC,,,,,,,BOTH,,,35.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMARY SET,83302-0,CDM,270,RC,,,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, IRRIGATION",80150-6,CDM,270,RC,,,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, SUTURE REMOVAL",80159-7,CDM,270,RC,,,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREAM UREA 40%,83289-9,CDM,270,RC,,,,,,,BOTH,,,36.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE LG SHORT THIGH,82575-2,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH LARGE/LONG,81973-0,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH LARGE/REGULAR,81974-8,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH MEDIUM/LONG,81971-4,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH MEDIUM/REGULAR,81969-8,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH MEDIUM/SHORT,81972-2,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH SMALL/LONG,81968-0,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH SMALL/REGULAR,81967-2,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH SMALL/SHORT,81970-6,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE THIGH X-LARGE/LONG,81975-5,CDM,270,RC,,,,,,,BOTH,,,36.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GORE-TEX SUTURE THX-36,82434-2,CDM,270,RC,,,,,,,BOTH,,,36.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K WIRE,82835-0,CDM,270,RC,,,,,,,BOTH,,,36.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSTEC-PERFORATED,82426-8,CDM,270,RC,,,,,,,BOTH,,,36.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSOR PED SP02,83282-4,CDM,270,RC,,,,,,,BOTH,,,36.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY FLANGE 4,82148-8,CDM,270,RC,,,,,,,BOTH,,,37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOMAHESIVE,80946-7,CDM,270,RC,,,,,,,BOTH,,,37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOLEY URINE METER,83352-5,CDM,270,RC,,,,,,,BOTH,,,37.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING TRUFORM XL,83027-3,CDM,270,RC,,,,,,,BOTH,,,37.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BANDAGE COVER ROLL 2,83034-9,CDM,270,RC,,,,,,,BOTH,,,38.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKINGS KNEE XXXLR,83305-3,CDM,270,RC,,,,,,,BOTH,,,38.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE ASP 22GX50MM,83160-2,CDM,270,RC,,,,,,,BOTH,,,38.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GALACTOGRAM CATHETER,82703-0,CDM,270,RC,,,,,,,BOTH,,,38.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAG SPECIMEN RETVL,83086-9,CDM,270,RC,,,,,,,BOTH,,,38.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LONG ARM PLASTER SPLINT,82333-6,CDM,270,RC,,,,,,,BOTH,,,38.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LONG LEG PLASTER SPLINT,82362-5,CDM,270,RC,,,,,,,BOTH,,,38.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLAM FORRECTER,80348-6,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCA PUMP,960003-2,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PELVIC EXAM,960517-1,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRACTION ALL SIZES,960521-3,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, EAR IRRIG.",80147-2,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URETHRAL DIALATOR,80181-1,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URETHRAL DIL,871181-4,CDM,270,RC,,,,,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, ASPIRATION SONO VU",82743-6,CDM,270,RC,,,,,,,BOTH,,,39.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLES KEITH EXTRA,10426-5,CDM,270,RC,,,,,,,BOTH,,,39.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORGEN LENS,82714-7,CDM,270,RC,,,,,,,BOTH,,,40,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL PACKING SMALL,82303-9,CDM,270,RC,,,,,,,BOTH,,,40.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 1/4,82143-9,CDM,270,RC,,,,,,,BOTH,,,40.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSOR ADULT SP02,83284-0,CDM,270,RC,,,,,,,BOTH,,,40.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP SUTURE TRAY,81913-6,CDM,270,RC,,,,,,,BOTH,,,40.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IVAC ADM SET,80200-9,CDM,270,RC,,,,,,,BOTH,,,41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYCERINE SET,83300-4,CDM,270,RC,,,,,,,BOTH,,,41.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EZEFORM INSERT,83057-0,CDM,270,RC,,,,,,,BOTH,,,41.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PULSED LAVAGE TIP,82468-0,CDM,270,RC,,,,,,,BOTH,,,41.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-4'S INSERT,82670-1,CDM,270,RC,,,,,,,BOTH,,,41.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EMERGENCY OB KIT,83324-4,CDM,270,RC,,,,,,,BOTH,,,41.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY DR PCH 4,82145-4,CDM,270,RC,,,,,,,BOTH,,,41.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POUCH COLOSTOMY 21/2,82739-4,CDM,270,RC,,,,,,,BOTH,,,41.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND CLOSURE WIDE,83374-9,CDM,270,RC,,,,,,,BOTH,,,41.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESMARK BANDAGE,81943-3,CDM,270,RC,,,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
6 FRENCH SILICONE CATH,82417-7,CDM,270,RC,,,,,,,BOTH,,,42.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIQUIBAND DOME TIP,83063-8,CDM,270,RC,,,,,,,BOTH,,,42.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOLOGY BRUSH,82742-8,CDM,270,RC,,,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE KNEE HIGH TED,80379-1,CDM,270,RC,,,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL PACKING LARGE,82302-1,CDM,270,RC,,,,,,,BOTH,,,43.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THORACOSTOMY TRAY,82817-8,CDM,270,RC,,,,,,,BOTH,,,43.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TORSO SUPPORT-RESTRAINT,82864-0,CDM,270,RC,,,,,,,BOTH,,,43.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND DRAIN. COLLECT,80188-6,CDM,270,RC,,,,,,,BOTH,,,43.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADULT PULL UPS,82907-7,CDM,270,RC,,,,,,,BOTH,,,43.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CORD BIPOLAR DISP,82573-7,CDM,270,RC,,,,,,,BOTH,,,43.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COUDE CATHETER 18FR 5CC,82894-7,CDM,270,RC,,,,,,,BOTH,,,43.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COUDE CATHETER 20FR 5CC,82895-4,CDM,270,RC,,,,,,,BOTH,,,43.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COUDE CATHETER 22 FR 5CC,82896-2,CDM,270,RC,,,,,,,BOTH,,,43.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE CALDWELL 3.25,83141-2,CDM,270,RC,,,,,,,BOTH,,,43.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE CALDWELL 4.75,83142-0,CDM,270,RC,,,,,,,BOTH,,,43.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEEDING TUBE 16 FR MAGNAPORT,82848-3,CDM,270,RC,,,,,,,BOTH,,,44.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDAPORE TAPE,82477-1,CDM,270,RC,,,,,,,BOTH,,,44.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BIS SENSOR,82617-2,CDM,270,RC,,,,,,,BOTH,,,44.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIQUIBAND FLOW CTRL,83064-6,CDM,270,RC,,,,,,,BOTH,,,44.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY INJECTOR,83079-4,CDM,270,RC,,,,,,,BOTH,,,45.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONITOR CARDIAC,960513-0,CDM,270,RC,,,,,,,BOTH,,,45.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPLINTS, ALL SIZES",80329-6,CDM,270,RC,,,,,,,BOTH,,,45.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADULT PULL UPS MED,82908-5,CDM,270,RC,,,,,,,BOTH,,,45.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FEM CANAL BRUSH,82502-6,CDM,270,RC,,,,,,,BOTH,,,46.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF CLICK,83166-9,CDM,270,RC,,,,,,,BOTH,,,46.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSOR INFANT SP02,83283-2,CDM,270,RC,,,,,,,BOTH,,,46.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLAIN SHOWER DRAPE,82483-9,CDM,270,RC,,,,,,,BOTH,,,47.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LONG ARM SCOTCH CAST SPLINT,82406-0,CDM,270,RC,,,,,,,BOTH,,,48.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY DR P 1 1/8,83147-9,CDM,270,RC,,,,,,,BOTH,,,48.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DERMABND,82846-7,CDM,270,RC,,,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN CAN SCREW SHRT T,80235-5,CDM,270,RC,,,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVER UNDERBODY ADLT,83395-4,CDM,270,RC,,,,,,,BOTH,,,49.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENT PAC,82336-9,CDM,270,RC,,,,,,,BOTH,,,49.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROCKER SWITCH SMOKE PENCIL,82427-6,CDM,270,RC,,,,,,,BOTH,,,49.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 20FR,83131-3,CDM,270,RC,,,,,,,BOTH,,,49.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 22FR,83132-1,CDM,270,RC,,,,,,,BOTH,,,49.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILATOR 24FR,83133-9,CDM,270,RC,,,,,,,BOTH,,,49.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KINGVISION LARYNGOSC,83311-1,CDM,270,RC,,,,,,,BOTH,,,49.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3.5 MM CORTICAL SCREW 10MM,82839-2,CDM,270,RC,,,,,,,BOTH,,,49.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3.5 MM CORTICAL SCREW 12MM,82838-4,CDM,270,RC,,,,,,,BOTH,,,49.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, PREP SURGICAL",80156-3,CDM,270,RC,,,,,,,BOTH,,,50.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, ST. CATHETER",80140-7,CDM,270,RC,,,,,,,BOTH,,,50.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPIDURAL TRAY,82286-6,CDM,270,RC,,,,,,,BOTH,,,50.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FELT ORTHO 1/2'',80336-1,CDM,270,RC,,,,,,,BOTH,,,50.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAP CHOLE SUTURE,82259-3,CDM,270,RC,,,,,,,BOTH,,,50.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CONNECTING TUBE 30CM,83340-0,CDM,270,RC,,,,,,,BOTH,,,50.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RAE TRACH TUBE,80951-7,CDM,270,RC,,,,,,,BOTH,,,51.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNA-PORT 14FR,83349-1,CDM,270,RC,,,,,,,BOTH,,,52.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOSE TED,80088-8,CDM,270,RC,,,,,,,BOTH,,,52.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC MED DRESSING DR,83169-3,CDM,270,RC,,,,,,,BOTH,,,52.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEIMLICH VALVE,82932-5,CDM,270,RC,,,,,,,BOTH,,,52.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE CUTTER KNIFE,82563-8,CDM,270,RC,,,,,,,BOTH,,,53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO KITTNERS,82348-4,CDM,270,RC,,,,,,,BOTH,,,53.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIN STRINAMN PLAIN,10433-1,CDM,270,RC,,,,,,,BOTH,,,53.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 10 FR,81987-0,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 16 FR 30CC,81999-5,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 16 FR 5CC,81998-7,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 22 FR 30CC,81997-9,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 24 FR 30CC,82001-9,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOLEY 8 FR,81986-2,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, SUTURE EMERG",80146-4,CDM,270,RC,,,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, TEMNO COAXIAL",82778-2,CDM,270,RC,,,,,,,BOTH,,,54.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBIDE BUR OVAL 4.0,82370-8,CDM,270,RC,,,,,,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 22 FR 5CC,82049-8,CDM,270,RC,,,,,,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 22FR 30CC,82052-2,CDM,270,RC,,,,,,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYELOGRAM TRAY,82408-6,CDM,270,RC,,,,,,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HP MONITOR PADS,81929-2,CDM,270,RC,,,,,,,BOTH,,,55.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAST PATCH,82578-6,CDM,270,RC,,,,,,,BOTH,,,55.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BINDER ABDOMINAL,83239-4,CDM,270,RC,,,,,,,BOTH,,,56.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, CYSTOCOPY SET",80144-9,CDM,270,RC,,,,,,,BOTH,,,56.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN WASHER F-4ML CAN,80236-3,CDM,270,RC,,,,,,,BOTH,,,57.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ENDOTROL 6.0,82181-9,CDM,270,RC,,,,,,,BOTH,,,57.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ENDOTROL 7.0,82180-1,CDM,270,RC,,,,,,,BOTH,,,57.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE ENDOTROL 8.0,82179-3,CDM,270,RC,,,,,,,BOTH,,,57.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAD BED SENSOR,82776-6,CDM,270,RC,,,,,,,BOTH,,,57.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TURY-IRRIGATION SET,80224-9,CDM,270,RC,,,,,,,BOTH,,,57.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"VEST, POSEY SMALL",82917-6,CDM,270,RC,,,,,,,BOTH,,,57.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SWIFTSET SKIN ADH,83163-6,CDM,270,RC,,,,,,,BOTH,,,57.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY AUTO TRANSFUSN,80136-5,CDM,270,RC,,,,,,,BOTH,,,58.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, CHEST DRAINAGE",80141-5,CDM,270,RC,,,,,,,BOTH,,,58.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAYS, ASPIRATION",80135-7,CDM,270,RC,,,,,,,BOTH,,,58.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THORACOTOMY KIT,82262-7,CDM,270,RC,,,,,,,BOTH,,,58.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACK SUPPORT 2X,83054-7,CDM,270,RC,,,,,,,BOTH,,,58.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAWKINS II NEELDE 12.5 CM,82629-7,CDM,270,RC,,,,,,,BOTH,,,60,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAWKINS II NEEDLE 10 CM,82628-9,CDM,270,RC,,,,,,,BOTH,,,60,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 12FR,82172-8,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 28FR,82173-6,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 32FR,82174-4,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 36 FR,82170-2,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER THORACIC 40FR,82171-0,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THORACIC CATHETER,80449-2,CDM,270,RC,,,,,,,BOTH,,,60.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSUFLATOR TUBING,82258-5,CDM,270,RC,,,,,,,BOTH,,,60.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE CALD 18GX4.75,83345-9,CDM,270,RC,,,,,,,BOTH,,,61.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD FILTER,80166-2,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD TRANSFUS. FLTR,80508-5,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTROSTOMY TUBE MAGNA PORT,82849-1,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MITTON HAND ONE CHG,80339-5,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAPLER SKIN EXTRACT,10440-6,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, INDT. LARYNOG.",80149-8,CDM,270,RC,,,,,,,BOTH,,,61.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 1/4,83115-6,CDM,270,RC,,,,,,,BOTH,,,61.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAP SHEETS,82484-7,CDM,270,RC,,,,,,,BOTH,,,62.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SECUR ACATH,83199-0,CDM,270,RC,,,,,,,BOTH,,,62.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHAMPOO BASIN,83202-2,CDM,270,RC,,,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP ELECTRODE,390036-2,CDM,270,RC,,,,,,,BOTH,,,63.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TENS ELECTRODES,391036-1,CDM,270,RC,,,,,,,BOTH,,,63.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP LAP SPONGES,10417-4,CDM,270,RC,,,,,,,BOTH,,,64.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAP PK DISP CLINIC,11417-3,CDM,270,RC,,,,,,,BOTH,,,64.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3.5MM CORTICAL SCREW 36 MM,82837-6,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
3.5 MM CORTICAL SCREW 30 MM,82836-8,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUIDE PIN,82891-3,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONITOR KIT NURSING,960514-8,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SILVASORB GEL 1.5,82947-3,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, FOLEY CATHETER",80139-9,CDM,270,RC,,,,,,,BOTH,,,64.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINGER SPLINT LEATHR,80353-6,CDM,270,RC,,,,,,,BOTH,,,65.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT FINGER LEATHER,82070-4,CDM,270,RC,,,,,,,BOTH,,,65.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINT THUMB LEATHER,82071-2,CDM,270,RC,,,,,,,BOTH,,,65.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RADIAL ARTERY CATH,80504-4,CDM,270,RC,,,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SHEET, DISP EXTRA",80101-9,CDM,270,RC,,,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING TRUFORM XXL,83028-1,CDM,270,RC,,,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMPERSOL SET,80197-7,CDM,270,RC,,,,,,,BOTH,,,66.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO TUBE W/CONTROL,80903-8,CDM,270,RC,,,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRAOSSEOUS NDLE 16G,81946-6,CDM,270,RC,,,,,,,BOTH,,,67.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRAOSSEOUS NDLE 18G,82388-0,CDM,270,RC,,,,,,,BOTH,,,67.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACK SUPPORT 3X,83055-4,CDM,270,RC,,,,,,,BOTH,,,67.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 3/4,83019-0,CDM,270,RC,,,,,,,BOTH,,,67.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KIT ARTERIAL VENOUS,80505-1,CDM,270,RC,,,,,,,BOTH,,,68.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARGLAES POWDER,82955-6,CDM,270,RC,,,,,,,BOTH,,,68.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING WOUNDPRO LG,83233-7,CDM,270,RC,,,,,,,BOTH,,,68.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLEX-TIP URETH CATH,10414-1,CDM,270,RC,,,,,,,BOTH,,,69.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY KING SIZE,83220-4,CDM,270,RC,,,,,,,BOTH,,,69.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY KING SIZE 2.5,83221-2,CDM,270,RC,,,,,,,BOTH,,,69.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLEAR-TRAC CANNULA KIT,82624-8,CDM,270,RC,,,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL RHINO PAC,83026-5,CDM,270,RC,,,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRSG MEPILEX AG 8X8,83225-3,CDM,270,RC,,,,,,,BOTH,,,70.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEIMLICK CHEST DRAIN,10416-6,CDM,270,RC,,,,,,,BOTH,,,70.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENODYNEE BOOT,83013-3,CDM,270,RC,,,,,,,BOTH,,,70.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARMING BLANKET FULL,83023-2,CDM,270,RC,,,,,,,BOTH,,,71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOG ZAPPER,83338-4,CDM,270,RC,,,,,,,BOTH,,,71.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN CORTEX SCREW,80233-0,CDM,270,RC,,,,,,,BOTH,,,71.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POSEY VEST RESTRAINT,80341-1,CDM,270,RC,,,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VEST POSEY ECONO,82060-5,CDM,270,RC,,,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VEST POSEY LARGE,82061-3,CDM,270,RC,,,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VEST POSEY ECONO X-LARGE,82062-1,CDM,270,RC,,,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CVP MANOMETER,80193-6,CDM,270,RC,,,,,,,BOTH,,,72.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAND CONTROL BOVIE,10413-3,CDM,270,RC,,,,,,,BOTH,,,72.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL SPLINT (LG),82324-5,CDM,270,RC,,,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL SPLINT (MED),82322-9,CDM,270,RC,,,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K-WIRE THREADED .062 X 6 IN,82436-7,CDM,270,RC,,,,,,,BOTH,,,73.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYTAN VENT TUBE,81923-5,CDM,270,RC,,,,,,,BOTH,,,73.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALARM CHAIR SENSOR N,83408-5,CDM,270,RC,,,,,,,BOTH,,,73.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WIRE KERSCHNER AL/SZ,10443-0,CDM,270,RC,,,,,,,BOTH,,,74.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRESSING AQCEL 8X12,83224-6,CDM,270,RC,,,,,,,BOTH,,,74.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LARYNGEAL MASK 3.0,82983-8,CDM,270,RC,,,,,,,BOTH,,,75.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BLOOD FILTER, V-SET",80220-7,CDM,270,RC,,,,,,,BOTH,,,75.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY D PH 2 1/4,82930-9,CDM,270,RC,,,,,,,BOTH,,,75.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"FLANGE W/WAFER 2 1/4 HOLLISTER""",82929-1,CDM,270,RC,,,,,,,BOTH,,,75.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEDGE ANGLE,83150-3,CDM,270,RC,,,,,,,BOTH,,,75.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 1/4,83149-5,CDM,270,RC,,,,,,,BOTH,,,75.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE PLAIN 6-0 EYE,80112-6,CDM,270,RC,,,,,,,BOTH,,,76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IOBAN SHOWER DRAPE,82482-1,CDM,270,RC,,,,,,,BOTH,,,76.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUIK COMBO PED ELECTRODE,82974-7,CDM,270,RC,,,,,,,BOTH,,,76.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HANGING CAST SPLINT,80360-1,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAP SMEAR,960516-3,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SPINAL, STOPCOCK",80157-1,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, CUT DOWN",80143-1,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, PARACENTESIS",80152-2,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, PRE-CIP (OB)",80154-8,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, THORANCENTESIS",80160-5,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAYS BONE MARROW,80137-3,CDM,270,RC,,,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE MAGNA PORT 24FR,83049-7,CDM,270,RC,,,,,,,BOTH,,,77.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 3\4,83020-8,CDM,270,RC,,,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR SUPPORT SMALL,83050-5,CDM,270,RC,,,,,,,BOTH,,,78.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP PRESSURE INFUSOR,82317-9,CDM,270,RC,,,,,,,BOTH,,,79.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARMING BLANKET,81914-4,CDM,270,RC,,,,,,,BOTH,,,79.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOCKING THG 30X40,83191-7,CDM,270,RC,,,,,,,BOTH,,,80.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHAIR SENSOR PAD,82777-4,CDM,270,RC,,,,,,,BOTH,,,80.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER SUBCLAVIN,80039-1,CDM,270,RC,,,,,,,BOTH,,,81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIN STRINAMN THREAD,10434-9,CDM,270,RC,,,,,,,BOTH,,,81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLEUR DRY SUCTION,83273-3,CDM,270,RC,,,,,,,BOTH,,,81.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 1/4,83116-4,CDM,270,RC,,,,,,,BOTH,,,81.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAUTERY ACCU TEMP,10409-1,CDM,270,RC,,,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHAMPOO T GEL,83360-8,CDM,270,RC,,,,,,,BOTH,,,82.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC CANISTER DR,83168-5,CDM,270,RC,,,,,,,BOTH,,,82.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND PRO CANNISTER,83237-8,CDM,270,RC,,,,,,,BOTH,,,82.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR SUPPORT LARGE,83052-1,CDM,270,RC,,,,,,,BOTH,,,82.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR SUPPORT MED,83051-3,CDM,270,RC,,,,,,,BOTH,,,82.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR SUPPORT X-LG,83053-9,CDM,270,RC,,,,,,,BOTH,,,82.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH 2 3/4,82716-2,CDM,270,RC,,,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K-WIRE W/PIN GUARD .045,82377-3,CDM,270,RC,,,,,,,BOTH,,,86.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K-WIRE W/PIN GUARD .062 X 9,82378-1,CDM,270,RC,,,,,,,BOTH,,,86.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOURNIQUET CUFF LONG,82361-7,CDM,270,RC,,,,,,,BOTH,,,86.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABDUCTION PILLOW SMALL,82510-9,CDM,270,RC,,,,,,,BOTH,,,87.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUIDWIRE VSI,83098-4,CDM,270,RC,,,,,,,BOTH,,,87.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"GRANULEX, SPRAY",80084-7,CDM,270,RC,,,,,,,BOTH,,,87.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC-GRANUFOAM SMALL DRESSING,82924-2,CDM,270,RC,,,,,,,BOTH,,,88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY SKIN STRIP,83270-9,CDM,270,RC,,,,,,,BOTH,,,89.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PED FOLEY CATH W/STY,81926-8,CDM,270,RC,,,,,,,BOTH,,,90.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUIDE WIRE BENTSON,83101-6,CDM,270,RC,,,,,,,BOTH,,,90.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE COAXIAL 18X11,83039-8,CDM,270,RC,,,,,,,BOTH,,,90.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE COAXIAL 18X15,83038-0,CDM,270,RC,,,,,,,BOTH,,,90.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP BIOPSY FORCEPS,82301-3,CDM,270,RC,,,,,,,BOTH,,,91.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREWS,10438-0,CDM,270,RC,,,,,,,BOTH,,,91.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADHESIVE MED SPRAY,82998-6,CDM,270,RC,,,,,,,BOTH,,,91.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DUO-TUBE,80939-2,CDM,270,RC,,,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEDGING,80317-1,CDM,270,RC,,,,,,,BOTH,,,93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOLISTER POUCH 2 1/4 IN,82709-7,CDM,270,RC,,,,,,,BOTH,,,93.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNA PORT GASTROSTOMY TUBE 18F,82963-0,CDM,270,RC,,,,,,,BOTH,,,93.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNA PORT GASTROSTOMY TUBE 22 FR,82964-8,CDM,270,RC,,,,,,,BOTH,,,93.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNA-PORT-GASTROSTOMY TUBE 20,82913-5,CDM,270,RC,,,,,,,BOTH,,,93.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY DR PCH 2.5,83162-8,CDM,270,RC,,,,,,,BOTH,,,93.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALARM BED SENSOR,83398-8,CDM,270,RC,,,,,,,BOTH,,,94.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 8 FR.,80030-0,CDM,270,RC,,,,,,,BOTH,,,94.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN SARATOGA SUMP,80061-5,CDM,270,RC,,,,,,,BOTH,,,94.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, BONE BIOPSY 11 GAUGE",82793-1,CDM,270,RC,,,,,,,BOTH,,,95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, BONE BIOPSY 13 GAUGE",82794-9,CDM,270,RC,,,,,,,BOTH,,,95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAND,80359-3,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP-SHOE SMALL WOMAN,82191-8,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP-SHOE MEDIUM WOMEN,82192-6,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP-SHOE SMALL MEN,82193-4,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST OP-SHOE LARGE MEN,82194-2,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POST-OP-SHOE,81455-8,CDM,270,RC,,,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DERMABOND PEN,83025-7,CDM,270,RC,,,,,,,BOTH,,,96.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MATTRESS WAFFLE,83103-2,CDM,270,RC,,,,,,,BOTH,,,97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEEL FLOAT WIPE CLN,83222-0,CDM,270,RC,,,,,,,BOTH,,,97.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPEED HAND SPLINT,80918-6,CDM,270,RC,,,,,,,BOTH,,,97.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ELECTRODES, QUIK-COMBO",82973-9,CDM,270,RC,,,,,,,BOTH,,,98.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERCUT SHEATH KIT,81945-8,CDM,270,RC,,,,,,,BOTH,,,98.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC-ATS CANISTER W/GEL 500ML,82925-9,CDM,270,RC,,,,,,,BOTH,,,99.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL HEMOSTATIC KIT,80091-2,CDM,270,RC,,,,,,,BOTH,,,100.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONOPTY BIOPSY NEEDLE,822957-7,CDM,270,RC,,,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOURNIQUET EXTREMITY,83267-5,CDM,270,RC,,,,,,,BOTH,,,101.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEX CRIME KIT,80100-1,CDM,270,RC,,,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY PARACENTESIS,83069-5,CDM,270,RC,,,,,,,BOTH,,,103.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VSI GUIDEWIRE 130CM,83246-9,CDM,270,RC,,,,,,,BOTH,,,103.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOLANGIOGRAPHY SET,82341-9,CDM,270,RC,,,,,,,BOTH,,,104,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY PCH CLICK,83165-1,CDM,270,RC,,,,,,,BOTH,,,104.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREWS 1.5,83122-2,CDM,270,RC,,,,,,,BOTH,,,105.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXPRESS CORE BIOPSY DEVICE 18 GA,82769-1,CDM,270,RC,,,,,,,BOTH,,,106.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE TURKLE THORAC,83263-4,CDM,270,RC,,,,,,,BOTH,,,106.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO/CHOLANGRAM SET 300,82409-4,CDM,270,RC,,,,,,,BOTH,,,107.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO/CHOLANGRAM SET 400,82410-2,CDM,270,RC,,,,,,,BOTH,,,107.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, COAXIAL ACHIEVE CA1815",82780-8,CDM,270,RC,,,,,,,BOTH,,,108,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SINGLE SHOT EPIDURAL TRAY,82583-6,CDM,270,RC,,,,,,,BOTH,,,108,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICRO PUNCTURE INTRODUCER,82830-1,CDM,270,RC,,,,,,,BOTH,,,108.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTRIC LAVAGE KIT,80937-6,CDM,270,RC,,,,,,,BOTH,,,110,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEDI-LUMBAR TRAY,80909-5,CDM,270,RC,,,,,,,BOTH,,,110.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER WOVEN,80041-7,CDM,270,RC,,,,,,,BOTH,,,110.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY WF 2 3/4,82149-6,CDM,270,RC,,,,,,,BOTH,,,110.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAMMOLOK NEEDLE,81910-2,CDM,270,RC,,,,,,,BOTH,,,110.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY KING SIZE 3,83046-3,CDM,270,RC,,,,,,,BOTH,,,110.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY KING SIZE 4,83045-5,CDM,270,RC,,,,,,,BOTH,,,110.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AIRWAY KING SIZE 5,83044-8,CDM,270,RC,,,,,,,BOTH,,,110.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PIN, RUSH MEDULLARY",10432-3,CDM,270,RC,,,,,,,BOTH,,,112.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY,80029-2,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 16FR,82046-4,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 20FR 5CC,82048-0,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 24 FR 5CC,82050-6,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 20 FR 30CC,82051-4,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 24FR WITH 30CC,82053-0,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER 3-WAY 18 FR 5CC,82047-2,CDM,270,RC,,,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, COAXIAL TEMNO BIOPSY 1815",82779-0,CDM,270,RC,,,,,,,BOTH,,,115.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR 12MM BLT TIP,83090-1,CDM,270,RC,,,,,,,BOTH,,,115.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOOT & ANKLE INFLTBL,80356-9,CDM,270,RC,,,,,,,BOTH,,,115.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FULL ARM INFLATABLE,80357-7,CDM,270,RC,,,,,,,BOTH,,,115.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR W/CANNULA 5MM,82916-8,CDM,270,RC,,,,,,,BOTH,,,116.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BONE MARROW TRAY,82314-6,CDM,270,RC,,,,,,,BOTH,,,118,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLES TRU-CUT BIOP,10428-1,CDM,270,RC,,,,,,,BOTH,,,120.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAX-CORE BIOPSY NDLE 14X16,82345-0,CDM,270,RC,,,,,,,BOTH,,,121.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN CANC SCREW FUL T,80234-8,CDM,270,RC,,,,,,,BOTH,,,121.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOLISTER FLANGE 1 1/4 INCH,82710-5,CDM,270,RC,,,,,,,BOTH,,,123,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOREIGN BODY REMOVER,83323-6,CDM,270,RC,,,,,,,BOTH,,,123.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC VERALINK CASSETT,83397-0,CDM,270,RC,,,,,,,BOTH,,,127.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER CHOLANGIOG,80027-6,CDM,270,RC,,,,,,,BOTH,,,128.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEMNO BIOPSY SYSTEM,82771-7,CDM,270,RC,,,,,,,BOTH,,,129.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEMNO BIOPSY SYSTEM,82772-5,CDM,270,RC,,,,,,,BOTH,,,129.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNISUC REPLACE BAGS,83358-2,CDM,270,RC,,,,,,,BOTH,,,129.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KIT MICROINTRODUCER,83008-3,CDM,270,RC,,,,,,,BOTH,,,132.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE BIOPSY 18X15C,83009-1,CDM,270,RC,,,,,,,BOTH,,,132.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE BIOPSY 18X20C,83010-9,CDM,270,RC,,,,,,,BOTH,,,132.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIGMOIDSCOPY SUPPLIES,960518-9,CDM,270,RC,,,,,,,BOTH,,,132.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENOUS PRESSURE TRAY,80207-4,CDM,270,RC,,,,,,,BOTH,,,133.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRS SAW BLADE,82443-3,CDM,270,RC,,,,,,,BOTH,,,133.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUIK-PACE PAD,82424-3,CDM,270,RC,,,,,,,BOTH,,,133.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY - CIRCUMCISION,960524-7,CDM,270,RC,,,,,,,BOTH,,,135,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY THORACOTOMY,80163-9,CDM,270,RC,,,,,,,BOTH,,,135.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, TRACHEOTOMY",80161-3,CDM,270,RC,,,,,,,BOTH,,,135.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JEJUNAL FEEDING TUBE,82632-1,CDM,270,RC,,,,,,,BOTH,,,136.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAINAGE BAG 600ML,83402-8,CDM,270,RC,,,,,,,BOTH,,,136.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARCELL BUR 4.0,82801-2,CDM,270,RC,,,,,,,BOTH,,,138.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RESECTOR 4.0,82799-8,CDM,270,RC,,,,,,,BOTH,,,138.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RESECTOR 5.0,82800-4,CDM,270,RC,,,,,,,BOTH,,,138.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMOSTAT DRN VALVE,83262-6,CDM,270,RC,,,,,,,BOTH,,,139.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUICK PRESSURE MON SET,82507-5,CDM,270,RC,,,,,,,BOTH,,,141.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC-GRANUFOAM DRESSING-THIN,82941-6,CDM,270,RC,,,,,,,BOTH,,,141.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FECAL CORRECTION BAG,83003-4,CDM,270,RC,,,,,,,BOTH,,,141.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNISUC STARTER KIT,83357-4,CDM,270,RC,,,,,,,BOTH,,,141.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POSI-PULSE DRAINAGE,801232-0,CDM,270,RC,,,,,,,BOTH,,,142.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POSI-PULSE DRAINAGE,802232-9,CDM,270,RC,,,,,,,BOTH,,,142.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSI KIT 7 FRENCH,80919-4,CDM,270,RC,,,,,,,BOTH,,,142.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP PRESSURE MON,82471-4,CDM,270,RC,,,,,,,BOTH,,,142.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POSEY BOOT,80906-1,CDM,270,RC,,,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMPLACE MED. DRESSING,82949-9,CDM,270,RC,,,,,,,BOTH,,,143.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UROSTOMY POUCH CONVX,83269-1,CDM,270,RC,,,,,,,BOTH,,,145.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUIK PACE PATCHES,81930-0,CDM,270,RC,,,,,,,BOTH,,,147,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, NOZ-STOP",80509-3,CDM,270,RC,,,,,,,BOTH,,,149.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDO PEANUT,82325-2,CDM,270,RC,,,,,,,BOTH,,,149.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHILEY TRACH 8FR,83021-6,CDM,270,RC,,,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR W/CANNULA 11MM,82915-0,CDM,270,RC,,,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LOTTES INTRA NAILCLI,11424-9,CDM,270,RC,,,,,,,BOTH,,,150.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOGARTY IRRIG. CATH.,80901-2,CDM,270,RC,,,,,,,BOTH,,,151.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FULL LEG INFLATABLE,80358-5,CDM,270,RC,,,,,,,BOTH,,,154.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MESH,10419-0,CDM,270,RC,,,,,,,BOTH,,,154.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACK, PERI",80095-3,CDM,270,RC,,,,,,,BOTH,,,154.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE COAXEAL18GX20,83048-9,CDM,270,RC,,,,,,,BOTH,,,154.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRILL BIT 1.0,82919-2,CDM,270,RC,,,,,,,BOTH,,,156,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRILL BIT 1.3,82920-0,CDM,270,RC,,,,,,,BOTH,,,156,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICEL CELLULOSE,80107-6,CDM,270,RC,,,,,,,BOTH,,,157,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHORT LEG SPLINT/ORTHOGLASS,82721-2,CDM,270,RC,,,,,,,BOTH,,,158.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLEUR DRY SUCT MINI,83274-1,CDM,270,RC,,,,,,,BOTH,,,158.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC NEEDLE 24MM,82706-3,CDM,270,RC,,,,,,,BOTH,,,163,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PULSED LAVAGE HAND,82467-2,CDM,270,RC,,,,,,,BOTH,,,164,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THOROCENTESIS TRAY,80908-7,CDM,270,RC,,,,,,,BOTH,,,165.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KCI DRESSING LG BLK,83197-4,CDM,270,RC,,,,,,,BOTH,,,165.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORTHO GLASS LONG ARM SPLINT,82580-2,CDM,270,RC,,,,,,,BOTH,,,166,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, CHEST DRN 3BTL",80142-3,CDM,270,RC,,,,,,,BOTH,,,172,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DR RISEN PACK,82823-6,CDM,270,RC,,,,,,,BOTH,,,172.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MCSWAIN DART,80173-8,CDM,270,RC,,,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERIT LAVAGE CATH,80911-1,CDM,270,RC,,,,,,,BOTH,,,176,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APEX HALF PIN,82463-1,CDM,270,RC,,,,,,,BOTH,,,176.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
2 3/4 POST OP COL K,80954-1,CDM,270,RC,,,,,,,BOTH,,,176.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
1 PIECE CUSTOM POUCH,80945-9,CDM,270,RC,,,,,,,BOTH,,,177.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONE PIECE CUSTOM DR,80948-3,CDM,270,RC,,,,,,,BOTH,,,177.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPIDURAL CATH (TRAY),82795-6,CDM,270,RC,,,,,,,BOTH,,,180,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBULAR PLATE 1/32 6 HOLE,82447-4,CDM,270,RC,,,,,,,BOTH,,,181.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN TUBLAR PLATE,80238-9,CDM,270,RC,,,,,,,BOTH,,,182.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VEST WRAP SPU DISP,83258-4,CDM,270,RC,,,,,,,BOTH,,,183.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNA-PORT G-TUBE,83271-7,CDM,270,RC,,,,,,,BOTH,,,184.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ULTRACLIP MARKER,83014-1,CDM,270,RC,,,,,,,BOTH,,,186,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERIPHERALL CATHETER SET #501,82831-9,CDM,270,RC,,,,,,,BOTH,,,186.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERIPHERALLY CATHETER TRAY,82832-7,CDM,270,RC,,,,,,,BOTH,,,186.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOBBHOFF TUBE,80190-2,CDM,270,RC,,,,,,,BOTH,,,188.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSI PERCUTANEOUS KIT,80907-9,CDM,270,RC,,,,,,,BOTH,,,188.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EMERSON SET, TUBING",960507-2,CDM,270,RC,,,,,,,BOTH,,,189.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREW 1.3,82921-8,CDM,270,RC,,,,,,,BOTH,,,190.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYST SUTURE,82337-7,CDM,270,RC,,,,,,,BOTH,,,192.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLES BONE MARROW,10425-7,CDM,270,RC,,,,,,,BOTH,,,193.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBES, TRACH ALL/SIZ",80178-7,CDM,270,RC,,,,,,,BOTH,,,193.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHILEY TRACH TUBE 6FR,82901-0,CDM,270,RC,,,,,,,BOTH,,,194.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHILEY TRACH TUBE 8FR,82902-8,CDM,270,RC,,,,,,,BOTH,,,194.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LONG LEG SPLINT/ORTHOGLASS,82722-0,CDM,270,RC,,,,,,,BOTH,,,198,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TROCAR, BLUNT TIP 12MM",82914-3,CDM,270,RC,,,,,,,BOTH,,,198,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESOPHAGEAL TRACHEAL AIRWAY(COMBITUBE) 37FR,87880-1,CDM,270,RC,,,,,,,BOTH,,,198.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESOPHAGEAL TRACHEAL AIRWAY(COMBITUBE) 41FR,82881-4,CDM,270,RC,,,,,,,BOTH,,,198.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOVACS (SMALL),80087-0,CDM,270,RC,,,,,,,BOTH,,,199.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MILLER-ABBOTT,80174-6,CDM,270,RC,,,,,,,BOTH,,,199.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN K-WIRE,80242-1,CDM,270,RC,,,,,,,BOTH,,,200.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CURV ALUM ROD,82461-5,CDM,270,RC,,,,,,,BOTH,,,206,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKS, OB EXTRA",80094-6,CDM,270,RC,,,,,,,BOTH,,,207.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTRACTOR KATZ,83238-6,CDM,270,RC,,,,,,,BOTH,,,216.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOMACH INT TUBE,80930-1,CDM,270,RC,,,,,,,BOTH,,,219,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRILL BIT,83124-8,CDM,270,RC,,,,,,,BOTH,,,225.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MONITOR, FETAL HEART",960512-2,CDM,270,RC,,,,,,,BOTH,,,231.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TUBE, ESOPHAGEAL",80171-2,CDM,270,RC,,,,,,,BOTH,,,231.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RADIAL JAW 4 HOT,83097-6,CDM,270,RC,,,,,,,BOTH,,,232.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIMPLEX P RADIOPAQUE,82508-3,CDM,270,RC,,,,,,,BOTH,,,237.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UTERINE PACKING,80082-1,CDM,270,RC,,,,,,,BOTH,,,237.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAPLER-SKIN DISP,10439-8,CDM,270,RC,,,,,,,BOTH,,,239,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL TRAY,82405-2,CDM,270,RC,,,,,,,BOTH,,,241,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, SUPRA PUBIC",80158-9,CDM,270,RC,,,,,,,BOTH,,,241,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAP IRRIGATION TUBING,82256-9,CDM,270,RC,,,,,,,BOTH,,,242.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLEURX DRAINAGE KIT,83384-8,CDM,270,RC,,,,,,,BOTH,,,244.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE EZ-IO 15MM,83108-1,CDM,270,RC,,,,,,,BOTH,,,248,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE EZ-IO 25MM,83107-3,CDM,270,RC,,,,,,,BOTH,,,248,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICLIP - MED,82900-2,CDM,270,RC,,,,,,,BOTH,,,255,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEEDLE EZ-IO 45MM,83109-9,CDM,270,RC,,,,,,,BOTH,,,271.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VERSAPORT 5MM W/SHLO,82266-8,CDM,270,RC,,,,,,,BOTH,,,277.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CENTRAL VENEOUS,80910-3,CDM,270,RC,,,,,,,BOTH,,,278.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICLIP M-11.5,82265-0,CDM,270,RC,,,,,,,BOTH,,,283.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APPLIER MULTI CLIP,83076-0,CDM,270,RC,,,,,,,BOTH,,,285.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NON-RETRACTING FORCEPS MICROVASIVE-REF#1061,82853-3,CDM,270,RC,,,,,,,BOTH,,,288,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBING FLOW II,83082-8,CDM,270,RC,,,,,,,BOTH,,,292.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGIPORT 5MM TROCR KIT,82267-6,CDM,270,RC,,,,,,,BOTH,,,293,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"4 POST OP COL KIT""",80955-8,CDM,270,RC,,,,,,,BOTH,,,293.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATHETER FOGARTY,80033-4,CDM,270,RC,,,,,,,BOTH,,,293.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAUMA KIT,81949-0,CDM,270,RC,,,,,,,BOTH,,,295.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEDGE BARIATRIC,83313-7,CDM,270,RC,,,,,,,BOTH,,,297.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY POWER PICC 4FR,83022-4,CDM,270,RC,,,,,,,BOTH,,,301,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPH CATH 10.3,83335-0,CDM,270,RC,,,,,,,BOTH,,,311.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPH CATH 8.3,83334-3,CDM,270,RC,,,,,,,BOTH,,,311.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENTHRANE.MASK,960523-9,CDM,270,RC,,,,,,,BOTH,,,312.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRODUCER KIT CATH.,80502-8,CDM,270,RC,,,,,,,BOTH,,,316,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MESH, MARLEX",10420-8,CDM,270,RC,,,,,,,BOTH,,,316.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC VERIFLO DRESSING,83396-2,CDM,270,RC,,,,,,,BOTH,,,319.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYLAN VENT TUBE,81922-7,CDM,270,RC,,,,,,,BOTH,,,321.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY POWER PIC 5FR,83007-5,CDM,270,RC,,,,,,,BOTH,,,323.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGIPORT 10MM TROCAR SS,82268-4,CDM,270,RC,,,,,,,BOTH,,,329.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE TRACH EASY ADULT,82247-8,CDM,270,RC,,,,,,,BOTH,,,334,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE TRACH EASY INFANT,82248-6,CDM,270,RC,,,,,,,BOTH,,,334,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KIT NIAGRA CATH,83015-8,CDM,270,RC,,,,,,,BOTH,,,335,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THOMAS LEG ALL SIZE,80367-6,CDM,270,RC,,,,,,,BOTH,,,348,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN SM TUBULAR PLA,80239-7,CDM,270,RC,,,,,,,BOTH,,,350.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR 5-11 VERSA PT,83088-5,CDM,270,RC,,,,,,,BOTH,,,353.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAP CHOLE PAC,82260-1,CDM,270,RC,,,,,,,BOTH,,,353.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAY PNEUMOTHORAX,83040-6,CDM,270,RC,,,,,,,BOTH,,,355.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLOSTOMY P HI OP 2+,83156-0,CDM,270,RC,,,,,,,BOTH,,,356,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MESH PRE-SHAPED 10CMX4.5CM,82911-9,CDM,270,RC,,,,,,,BOTH,,,360,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR 100MM ENDPTH,83089-3,CDM,270,RC,,,,,,,BOTH,,,361.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRESSURE TRANSDUCER,80217-3,CDM,270,RC,,,,,,,BOTH,,,387.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TROCAR - BLUNT TIP,82307-0,CDM,270,RC,,,,,,,BOTH,,,394.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THOR-KLEX CHEST DRAN,80448-4,CDM,270,RC,,,,,,,BOTH,,,396,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HICKMAN CVP CATHETER,80506-9,CDM,270,RC,,,,,,,BOTH,,,399,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBING SURGICAL SUCTION DEVICE D,82934-1,CDM,270,RC,,,,,,,BOTH,,,414,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARISTA/AH HEMOSTAT,82999-4,CDM,270,RC,,,,,,,BOTH,,,414.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MESH-MARLEX,82910-1,CDM,270,RC,,,,,,,BOTH,,,417.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERMCATH 23CM,83102-4,CDM,270,RC,,,,,,,BOTH,,,437,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MURRAY THOMAS ARM SP,80364-3,CDM,270,RC,,,,,,,BOTH,,,439.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NU-TRAKE KIT, ADULT",82856-6,CDM,270,RC,,,,,,,BOTH,,,451,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PEDIA NU-TRAKE KIT,82857-4,CDM,270,RC,,,,,,,BOTH,,,451,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN DCP PLATE,80241-3,CDM,270,RC,,,,,,,BOTH,,,455.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZIPWIRE .038IN,83333-5,CDM,270,RC,,,,,,,BOTH,,,460.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFUSION KIT TRI-LUM,80501-0,CDM,270,RC,,,,,,,BOTH,,,464.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STAPLER/SKIN DISP CL,11439-7,CDM,270,RC,,,,,,,BOTH,,,469.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE-G,83105-7,CDM,270,RC,,,,,,,BOTH,,,470.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPLINTS ABDUCTOR,80344-5,CDM,270,RC,,,,,,,BOTH,,,473.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TRAY, PERTL-DIALYS.",80153-0,CDM,270,RC,,,,,,,BOTH,,,491.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APPLIER MULTICLIP5MM,83135-4,CDM,270,RC,,,,,,,BOTH,,,493.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
4 WIRE STONE BASKET,81374-1,CDM,270,RC,,,,,,,BOTH,,,501.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
4-WIRE STONE BASKET,80374-2,CDM,270,RC,,,,,,,BOTH,,,501.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
6-WIRE STONE BASKET,80375-9,CDM,270,RC,,,,,,,BOTH,,,501.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KUGEL PATCH,82845-9,CDM,270,RC,,,,,,,BOTH,,,504,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRACH EXCHANGE SET,83261-8,CDM,270,RC,,,,,,,BOTH,,,507.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUICKTRACH 2.0,82888-9,CDM,270,RC,,,,,,,BOTH,,,508.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUICKTRACH 4.0,82889-7,CDM,270,RC,,,,,,,BOTH,,,508.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABSOLUTE TAPERED PIN,82365-8,CDM,270,RC,,,,,,,BOTH,,,510,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDTRONIC LEADS DISP,960511-4,CDM,270,RC,,,,,,,BOTH,,,516,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE GASTROMICKEY5.0,83351-7,CDM,270,RC,,,,,,,BOTH,,,527.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CONNULATED SCREW 3.0,82890-5,CDM,270,RC,,,,,,,BOTH,,,529.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAUDERER-PONSKY TUBE,80950-9,CDM,270,RC,,,,,,,BOTH,,,567.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KIT T-GSTRC JEJUMAL,83146-1,CDM,270,RC,,,,,,,BOTH,,,569.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE GASTRO ENT 18FR,83182-6,CDM,270,RC,,,,,,,BOTH,,,590.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE FEED GJ 18FR,83183-4,CDM,270,RC,,,,,,,BOTH,,,591.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FECAL FLEXI SEAL,83000-0,CDM,270,RC,,,,,,,BOTH,,,618.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN SM OBL T-PLATE,80240-5,CDM,270,RC,,,,,,,BOTH,,,619.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
4 PRONG STONE FORCEP,81376-6,CDM,270,RC,,,,,,,BOTH,,,644.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
4-PRONG STONE FORCEP,80376-7,CDM,270,RC,,,,,,,BOTH,,,644.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH HEMODIALYSIS,83104-0,CDM,270,RC,,,,,,,BOTH,,,715,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATE LEFT,83123-0,CDM,270,RC,,,,,,,BOTH,,,720.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMALL CALCANEAL PLATE,82840-0,CDM,270,RC,,,,,,,BOTH,,,756,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FERNO TRACTION SPLIN,81927-6,CDM,270,RC,,,,,,,BOTH,,,775.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMODIALYSIS KIT 15F,83241-0,CDM,270,RC,,,,,,,BOTH,,,785.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH OUROFLOW 28CM,83201-4,CDM,270,RC,,,,,,,BOTH,,,791.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYN CLOVERLEAF PLATE,80237-1,CDM,270,RC,,,,,,,BOTH,,,829,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERCUTANIOUS NEPHROS,10431-5,CDM,270,RC,,,,,,,BOTH,,,928.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREW 2.5MM,83002-6,CDM,270,RC,,,,,,,BOTH,,,945,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE HARPOON 10,83119-8,CDM,270,RC,,,,,,,BOTH,,,966.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUTURE HARPOON 20,83120-6,CDM,270,RC,,,,,,,BOTH,,,966.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACKER,82433-4,CDM,270,RC,,,,,,,BOTH,,,972,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOPAZ MICRODEBRIDER,82951-5,CDM,270,RC,,,,,,,BOTH,,,1020,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASRTROSCOPE,960508-0,CDM,270,RC,,,,,,,BOTH,,,1020.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMART PORT CT,83068-7,CDM,270,RC,,,,,,,BOTH,,,1039.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMART PORT CT LOW-P,83084-4,CDM,270,RC,,,,,,,BOTH,,,1063.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASSURE CLOSURE 75 MILLIMETER,82255-1,CDM,270,RC,,,,,,,BOTH,,,1178.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
M/T PIN LCAMP,82451-6,CDM,270,RC,,,,,,,BOTH,,,1240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUBE GASTRO 14FR2.0,83306-1,CDM,270,RC,,,,,,,BOTH,,,1299.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLIP ENDO 5MM APPL,82933-3,CDM,270,RC,,,,,,,BOTH,,,1305.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABSORBATACK,83073-7,CDM,270,RC,,,,,,,BOTH,,,1457.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLEXIGLIDE 5X7X0.02CM,82936-6,CDM,270,RC,,,,,,,BOTH,,,1630.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARROWLOL DEVICE 16MM,83061-2,CDM,270,RC,,,,,,,BOTH,,,1653.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PATCH KUGEL HERNIA S,83087-7,CDM,270,RC,,,,,,,BOTH,,,1798.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DUAL MESB 15 X 19,82435-9,CDM,270,RC,,,,,,,BOTH,,,1954.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUTTER ENDOPATH 35MM,83111-5,CDM,270,RC,,,,,,,BOTH,,,2532.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOE JOINT PC ML,83067-9,CDM,270,RC,,,,,,,BOTH,,,2540.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PATCH KUGEL HERNIA,83075-2,CDM,270,RC,,,,,,,BOTH,,,2654.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUTTER RELOAD TSW35,83113-1,CDM,270,RC,,,,,,,BOTH,,,2734.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MOORE, PROTHESIS",10421-6,CDM,270,RC,,,,,,,BOTH,,,2896.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOE GREAT MP JOINT LG,11021-3,CDM,270,RC,,,,,,,BOTH,,,3505.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EXTERNAL FIXATOR,STD",82574-5,CDM,270,RC,,,,,,,BOTH,,,3527.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CUTTER RELOAD 35MM,83112-3,CDM,270,RC,,,,,,,BOTH,,,3749.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
M/T DYN TUBE 15MM,82449-0,CDM,270,RC,,,,,,,BOTH,,,3763.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBTALAR MBA IMPLANT,82775-8,CDM,270,RC,,,,,,,BOTH,,,4251.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH SIL 18FR 5CC,82057-1,CDM,270,RC,,,,,,,BOTH,,,52531.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EXTENSION SET 15"",10",83297-2,CDM,270,RC,,,,,,,BOTH,,,394,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYGEN DIV. CANNULA,81936-7,CDM,272,RC,,,,,,,BOTH,,,14.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBTALAR MBA IMPLANT 9MM,11445-4,CDM,278,RC,,,,,,,BOTH,,,2851.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPEC CO SNF/LAB CO19,101553-6,CDM,300,RC,G2024,HCPCS,,,,,BOTH,,,38.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPEC COLLECT COVID19,101552-8,CDM,300,RC,G2023,HCPCS,,,,,BOTH,,,35.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG CONF URINE 8-14,101726-8,CDM,300,RC,G0481,HCPCS,,,,,BOTH,,,391.47,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG CONF URINE 1-7,101725-0,CDM,300,RC,G0480,HCPCS,,,,,BOTH,,,283.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPRENORPHINE,99816-1,CDM,300,RC,G0434,HCPCS,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOSURE TEST,362-4,CDM,300,RC,G0328,HCPCS,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOSURE TEST,196-6,CDM,300,RC,G0328,HCPCS,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FECAL OCC BLD IMM SC,91060-4,CDM,300,RC,G0328,HCPCS,,,QW,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RESP PATHOGEN PANEL,101722-7,CDM,300,RC,0202U,CPT,,,,,BOTH,,,380,,,73,,166,146.2,166,1 through 10,percent of total billed charges,,,73,,166,146.2,166,1 through 10,percent of total billed charges,,,73,,166,146.2,166,1 through 10,percent of total billed charges,,,73,,166,146.2,166,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,200,200,200,1 through 10,percent of total billed charges,,,,
SPERM COUNT AFTER VAC,99232-1,CDM,300,RC,89321,CPT,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRYSTALS FLUID,99283-4,CDM,300,RC,89060,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOOL FOR WBC,91274-1,CDM,300,RC,89055,CPT,,,,,BOTH,,,120,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELL COUNT (SYN FLD),101222-8,CDM,300,RC,89051,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELL COUNT(SEND OUT),91282-4,CDM,300,RC,89051,CPT,,,,,BOTH,,,90,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELL COUNT,99427-7,CDM,300,RC,89050,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELL COUNT REPEAT,101416-6,CDM,300,RC,89050,CPT,,,91,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CIRCULATING TUMOR CELL,99864-1,CDM,300,RC,88361,CPT,,,,,BOTH,,,907,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IA INDIRECT,101274-9,CDM,300,RC,88347,CPT,,,,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IA INDIRECT,101275-6,CDM,300,RC,88347,CPT,,,91,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOFLUORESCENT EA AB INDIRECT,99831-0,CDM,300,RC,88347,CPT,,,,,BOTH,,,666,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTO MOLECULAR CYTO,101254-1,CDM,300,RC,88291,CPT,,,,,BOTH,,,190.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CGH-HR EA ADD,101449-7,CDM,300,RC,88289,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIGH RESOL STUDY ADD,101253-3,CDM,300,RC,88289,CPT,,,,,BOTH,,,190.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME ANALY ADD. KARYOTYPE,99845-0,CDM,300,RC,88280,CPT,,,,,BOTH,,,516,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTERPHASE IN SITU HYBRIDIZATION,99846-8,CDM,300,RC,88275,CPT,,,,,BOTH,,,516,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOMAL IN SITU HYBRIDIZATION,99847-6,CDM,300,RC,88273,CPT,,,,,BOTH,,,516,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME ANAL 20-25 CELLS,99849-2,CDM,300,RC,88264,CPT,,,,,BOTH,,,516,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME 15-20 CEL,101251-7,CDM,300,RC,88262,CPT,,,,,BOTH,,,190.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CGH-KARYOTYPE,101450-5,CDM,300,RC,88262,CPT,,,,,BOTH,,,340,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME ANALYSIS,99294-1,CDM,300,RC,88262,CPT,,,,,BOTH,,,968,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME ANALYSIS-HEMATOLOGY,99402-0,CDM,300,RC,88237,CPT,,,,,BOTH,,,1090,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE CULTURE LYMPH,101252-5,CDM,300,RC,88230,CPT,,,,,BOTH,,,190.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CGH-CHROM-HR,101448-9,CDM,300,RC,88230,CPT,,,,,BOTH,,,244,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOW CYT INTERP,101332-5,CDM,300,RC,88189,CPT,,,,,BOTH,,,405,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOW CYT ADD MARKER,101334-1,CDM,300,RC,88185,CPT,,,,,BOTH,,,68.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOW CYT 1ST MARKER,101333-3,CDM,300,RC,88184,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TZANCK,99610-8,CDM,300,RC,88161,CPT,,,,,BOTH,,,139,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
N MENINGITIS AG,99637-1,CDM,300,RC,87899,CPT,,,,,BOTH,,,115,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STREPT PNEUMONIA AG,99638-9,CDM,300,RC,87899,CPT,,,,,BOTH,,,115,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STREP SCREEN REPEAT,101023-0,CDM,300,RC,87880,CPT,,,91,,BOTH,,,83,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,7.2,8.8,1 through 10,percent of total billed charges,,,,
STREPT SCREEN,91075-2,CDM,300,RC,87880,CPT,,,QW,,BOTH,,,83,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,7.2,8.8,1 through 10,percent of total billed charges,,,,
STREP SCREEN RAPID,152-9,CDM,300,RC,87880,CPT,,,QW,,BOTH,,,105,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,7.2,8.8,1 through 10,percent of total billed charges,,,,
STREP SCREEN RAPID,320-2,CDM,300,RC,87880,CPT,,,QW,,BOTH,,,105,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,73,,9,9,9,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,7.2,8.8,1 through 10,percent of total billed charges,,,,
INFLUENZA A,99654-6,CDM,300,RC,87804,CPT,,,QW,,BOTH,,,32,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,32,9,32,1 through 10,percent of total billed charges,,,,
INFLUENZA A,161-0,CDM,300,RC,87804,CPT,,,QW,,BOTH,,,32,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,32,9,32,1 through 10,percent of total billed charges,,,,
INFLUENZA A,346-7,CDM,300,RC,87804,CPT,,,QW,,BOTH,,,32,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,32,9,32,1 through 10,percent of total billed charges,,,,
INFLUENZA B,99655-3,CDM,300,RC,87804,CPT,,,59,,BOTH,,,32,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,32,9,32,1 through 10,percent of total billed charges,,,,
INFLUENZA B,378-0,CDM,300,RC,87804,CPT,,,59,,BOTH,,,32,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,73,,9,9,32,82,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,32,9,32,1 through 10,percent of total billed charges,,,,
CL DIFFICILE TOXIN,91273-3,CDM,300,RC,87803,CPT,,,,,BOTH,,,119,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GROUP B STREP AG,99605-8,CDM,300,RC,87802,CPT,,,,,BOTH,,,115,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEGIONELLA AMP PROBE,101740-9,CDM,300,RC,87801,CPT,,,,,BOTH,,,175.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STREP A MOLECULAR,101698-9,CDM,300,RC,87651,CPT,,,QW,,BOTH,,,87.73,,,73,,58,29,87,1 through 10,percent of total billed charges,,,73,,58,29,87,1 through 10,percent of total billed charges,,,73,,58,29,87,1 through 10,percent of total billed charges,,,73,,58,29,87,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,87,87,87,1 through 10,percent of total billed charges,,,,
LIAT COVID/FLU PCR,101719-3,CDM,300,RC,87636,CPT,,,QW,,BOTH,,,142.63,,,73,,57,57,57,1 through 10,percent of total billed charges,,,73,,57,57,57,1 through 10,percent of total billed charges,,,73,,57,57,57,1 through 10,percent of total billed charges,,,73,,57,57,57,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID ABBOTT ID NOW,101658-3,CDM,300,RC,87635,CPT,,,QW,,BOTH,,,100,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,100,100,100,1 through 10,percent of total billed charges,,,,
COVID-19 AMP PRB,101550-2,CDM,300,RC,87635,CPT,,,QW,,BOTH,,,100,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,100,100,100,1 through 10,percent of total billed charges,,,,
COVID-19 AMP PRB,379-8,CDM,300,RC,87635,CPT,,,QW,,BOTH,,,100,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,100,100,100,1 through 10,percent of total billed charges,,,,
COVID-19 AMP PRB,190-9,CDM,300,RC,87635,CPT,,,QW,,BOTH,,,100,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,100,100,100,1 through 10,percent of total billed charges,,,,
COV-19 AMP PRB HGH T,101551-0,CDM,300,RC,87635,CPT,,,,,BOTH,,,149,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,73,,87,17.2,100,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,100,100,100,1 through 10,percent of total billed charges,,,,
M PNEUMONIAE MOLECUL,101545-2,CDM,300,RC,87581,CPT,,,,,BOTH,,,97.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEGIONELLA PNEUMO,101741-7,CDM,300,RC,87541,CPT,,,,,BOTH,,,117.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV ULTRA SENS RNA QUANT,99773-4,CDM,300,RC,87536,CPT,,,,,BOTH,,,555,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV RNA BY PCR,99781-7,CDM,300,RC,87522,CPT,,,,,BOTH,,,312,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV QUANTASURE,99955-7,CDM,300,RC,87522,CPT,,,,,BOTH,,,474.38,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEP C AMPLIFIED P/T,99210-7,CDM,300,RC,87521,CPT,,,,,BOTH,,,187,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HBV QUANT PCR,99720-5,CDM,300,RC,87517,CPT,,,,,BOTH,,,194,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GI PANEL PCR,101735-9,CDM,300,RC,87507,CPT,,,,,BOTH,,,1041.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV URINE PCR,101721-9,CDM,300,RC,87497,CPT,,,,,BOTH,,,223.28,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV PCR URINE,101732-6,CDM,300,RC,87496,CPT,,,,,BOTH,,,600,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C DIFF MOLECULAR,101544-5,CDM,300,RC,87493,CPT,,,,,BOTH,,,97.45,,,73,,29,26,97,1 through 10,percent of total billed charges,,,73,,29,26,97,1 through 10,percent of total billed charges,,,73,,29,26,97,1 through 10,percent of total billed charges,,,73,,29,26,97,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,28,28,28,1 through 10,percent of total billed charges,,,,
CANDIDA AURIS,110004-9,CDM,300,RC,87481,CPT,,,,,BOTH,,,87.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEGIONELLA UR AG,99495-4,CDM,300,RC,87449,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"COVID, FLU A, FLU B",99078-8,CDM,300,RC,87428,CPT,,,QW,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"COVID, FLU A, FLU B",189-1,CDM,300,RC,87428,CPT,,,QW,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AG IN-HOUSE,101342-4,CDM,300,RC,87426,CPT,,,QW,,BOTH,,,66.5,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AG IN-HOUSE,188-3,CDM,300,RC,87426,CPT,,,QW,,BOTH,,,66.5,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROTAVIRUS,91237-8,CDM,300,RC,87425,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HISTOPLASMA AG UR,101223-6,CDM,300,RC,87385,CPT,,,,,BOTH,,,230.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS BE AG,99549-8,CDM,300,RC,87350,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS B SURF AG,910781-4,CDM,300,RC,87340,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H PYLORI STOOL AG,99802-1,CDM,300,RC,87338,CPT,,,QW,,BOTH,,,187,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,10,10,1 through 10,percent of total billed charges,,,,
E COLI 0157:H7,99458-2,CDM,300,RC,87335,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GIARDIA AG,99769-2,CDM,300,RC,87329,CPT,,,,,BOTH,,,52,,,73,,52,52,52,1 through 10,percent of total billed charges,,,73,,52,52,52,1 through 10,percent of total billed charges,,,73,,52,52,52,1 through 10,percent of total billed charges,,,73,,52,52,52,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRYPTOSPORIDIUM - STOOL,99822-9,CDM,300,RC,87328,CPT,,,,,BOTH,,,367,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASP GALCT AG,101731-8,CDM,300,RC,87305,CPT,,,,,BOTH,,,225.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERPES SIMPLEX VIRUS,367-3,CDM,300,RC,87255,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERPES SIMPLEX VIRUS,197-4,CDM,300,RC,87255,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV CULTURE,99751-0,CDM,300,RC,87255,CPT,,,,,BOTH,,,102,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERPES CULTURE,91343-4,CDM,300,RC,87255,CPT,,,,,BOTH,,,266,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIRUS CULTURE,91256-8,CDM,300,RC,87252,CPT,,,,,BOTH,,,162,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C DIFFICILE TOXIN B,99527-4,CDM,300,RC,87230,CPT,,,,,BOTH,,,108,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"KOH PREP (HAIR, SKIN, NAIL)",99517-5,CDM,300,RC,87220,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KOH PREP (OTHER SOURCES),91159-4,CDM,300,RC,87210,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WET PREP,91061-2,CDM,300,RC,87210,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUNGAL SMEAR,101221-0,CDM,300,RC,87206,CPT,,,,,BOTH,,,19.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFB SMEAR,91066-1,CDM,300,RC,87206,CPT,,,,,BOTH,,,97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFB SENSITIVITY,91065-3,CDM,300,RC,87190,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SENSITIVITY,91182-6,CDM,300,RC,87186,CPT,,,,,BOTH,,,120,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6.5,6.1,6.9,1 through 10,percent of total billed charges,,,,
ANTIFUNG SENS**,101734-2,CDM,300,RC,87186,CPT,,,,,BOTH,,,1415.35,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6.5,6.1,6.9,1 through 10,percent of total billed charges,,,,
O&P CONCENTRATION,91069-5,CDM,300,RC,87177,CPT,,,,,BOTH,,,54.5,,,73,,34,9.1,54,1 through 10,percent of total billed charges,,,73,,34,9.1,54,1 through 10,percent of total billed charges,,,73,,34,9.1,54,1 through 10,percent of total billed charges,,,73,,34,9.1,54,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
AFB CULTURE,91064-6,CDM,300,RC,87116,CPT,,,,,BOTH,,,89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UREA/MYCOPLASMA CX,101752-4,CDM,300,RC,87109,CPT,,,,,BOTH,,,38.47,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUNGUS CULTURE,91068-7,CDM,300,RC,87101,CPT,,,,,BOTH,,,89,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANAEROBIC CULTURE,91077-8,CDM,300,RC,87075,CPT,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CULTURE CAMPLOBACTER,99529-0,CDM,300,RC,87046,CPT,,,,,BOTH,,,22,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
YERSINIA CULTURE,99497-0,CDM,300,RC,87046,CPT,,,,,BOTH,,,22,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
VIBRIO CULTURE,72827-9,CDM,300,RC,87046,CPT,,,,,BOTH,,,52,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,73,,11,6.5,22,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
BLOOD CULTURE 2ND SITE,99545-6,CDM,300,RC,87040,CPT,,,59,,BOTH,,,180,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,4,8,1 through 10,percent of total billed charges,,,,
BLOOD CULTURE 3RD SITE,99546-4,CDM,300,RC,87040,CPT,,,59,,BOTH,,,180,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,4,8,1 through 10,percent of total billed charges,,,,
BLOOD CULTURE,91070-3,CDM,300,RC,87040,CPT,,,,,BOTH,,,180,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,73,,7,7,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,4,8,1 through 10,percent of total billed charges,,,,
AFB CONCENTRATION TECH,99509-2,CDM,300,RC,87015,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS RETIC SEPARATION,99758-5,CDM,300,RC,86972,CPT,,,,,BOTH,,,256,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMPAT ANTIGLOB TECH,91259-2,CDM,300,RC,86922,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS PHENOTYPE,99553-0,CDM,300,RC,86906,CPT,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS RBC AGS (PHEN)/PT,99305-5,CDM,300,RC,86905,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS AG TYPE UN,99757-7,CDM,300,RC,86902,CPT,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - RH,99939-1,CDM,300,RC,86901,CPT,,,,,BOTH,,,12,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RH,99063-0,CDM,300,RC,86901,CPT,,,,,BOTH,,,32,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - ABO,99938-3,CDM,300,RC,86900,CPT,,,,,BOTH,,,12,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD TYPE,99062-2,CDM,300,RC,86900,CPT,,,,,BOTH,,,48,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC AB ID/EA REPEAT,101447-1,CDM,300,RC,86885,CPT,,,91,,BOTH,,,15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC AB ID/EA SELECTED REAGENT CELL,101030-5,CDM,300,RC,86885,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS DAT,99552-2,CDM,300,RC,86880,CPT,,,,,BOTH,,,26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIRECT COOMBS,91193-3,CDM,300,RC,86880,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS AB ID,99554-8,CDM,300,RC,86870,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - AB SCREEN,99937-5,CDM,300,RC,86850,CPT,,,,,BOTH,,,18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIBODY SCREEN,90035-7,CDM,300,RC,86850,CPT,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS C,99083-8,CDM,300,RC,86803,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROGLOBULIN AB,99395-6,CDM,300,RC,86800,CPT,,,,,BOTH,,,55,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VARICELLA ZOSTER AB IGM,99426-9,CDM,300,RC,86787,CPT,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHICKEN POX IGG (VARICELLA ZOSTER),99346-9,CDM,300,RC,86787,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FTA-ABS,99163-8,CDM,300,RC,86780,CPT,,,,,BOTH,,,37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOXOPLASMA IGG AB,99576-1,CDM,300,RC,86777,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COV-2 TOT AB INHOUSE,101549-4,CDM,300,RC,86769,CPT,,,,,BOTH,,,65.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUBEOLA ANTI IGG,99058-0,CDM,300,RC,86765,CPT,,,,,BOTH,,,83,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROCKY MT SPOTT FEVER IGG,91252-7,CDM,300,RC,86757,CPT,,,,,BOTH,,,162,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROCKY MT SPOT FEVIGM,99676-9,CDM,300,RC,86757,CPT,,,59,,BOTH,,,181,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,73,,13,0.01,167.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMOEBIC AB,99310-5,CDM,300,RC,86753,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPLASMA IGM,99182-8,CDM,300,RC,86738,CPT,,,,,BOTH,,,119,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUMPS AB IGM,99803-9,CDM,300,RC,86735,CPT,,,,,BOTH,,,46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISTERIA AB CF,101738-3,CDM,300,RC,86723,CPT,,,,,BOTH,,,177,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LISTERIA ANITBODY CF,101727-6,CDM,300,RC,86723,CPT,,,,,BOTH,,,177,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEGIONELLA ANTIBODIE,99126-5,CDM,300,RC,86713,CPT,,,,,BOTH,,,239,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS A IGM AB,910782-2,CDM,300,RC,86709,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS B SURF AB,910783-0,CDM,300,RC,86706,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS B CORE AB,99548-0,CDM,300,RC,86704,CPT,,,,,BOTH,,,60,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV,91269-1,CDM,300,RC,86703,CPT,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HISTOPLASMA AB,99635-5,CDM,300,RC,86698,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS DELTA,99344-4,CDM,300,RC,86692,CPT,,,,,BOTH,,,71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H PYLORI IGM,99448-3,CDM,300,RC,86677,CPT,,,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EB VIRUS, VIRAL CAPSID IGG",99646-2,CDM,300,RC,86665,CPT,,,,,BOTH,,,20,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EB VIRUS, VIRAL CAPSID IGM",96647-3,CDM,300,RC,86665,CPT,,,,,BOTH,,,20,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPSTEEN BARR VIRUS,99314-7,CDM,300,RC,86665,CPT,,,,,BOTH,,,79,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,73,,13.5,9.6,15,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EB VIRUS, NUCLEAR AG",99645-4,CDM,300,RC,86664,CPT,,,,,BOTH,,,20,,,73,,11.5,1,13,1 through 10,percent of total billed charges,,,73,,11.5,1,13,1 through 10,percent of total billed charges,,,73,,11.5,1,13,1 through 10,percent of total billed charges,,,73,,11.5,1,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"EB VIRUS, EARLY AG",99644-7,CDM,300,RC,86663,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COXSACKIE A VIRUS AB,99323-8,CDM,300,RC,86658,CPT,,,,,BOTH,,,248,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIPTHERIA ANTIBODY,99524-1,CDM,300,RC,86648,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV IGM,99351-9,CDM,300,RC,86645,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV IGG,99431-9,CDM,300,RC,86644,CPT,,,,,BOTH,,,137,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLAMYDIA TRACH IGM,99447-5,CDM,300,RC,86632,CPT,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRUCELLA ABORTUS,99614-0,CDM,300,RC,86622,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRUCELLA AB,99438-4,CDM,300,RC,86622,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARTONELLA HEN IGG,99663-7,CDM,300,RC,86611,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARTONELLA HEN IGM,99664-5,CDM,300,RC,86611,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARTONELLA QUIN IGG,99665-2,CDM,300,RC,86611,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARTONELLA QUINT IGM,99666-0,CDM,300,RC,86611,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS FLA,99479-8,CDM,300,RC,86606,CPT,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS FUM,99473-1,CDM,300,RC,86606,CPT,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RPR,91004-2,CDM,300,RC,86592,CPT,,,,,BOTH,,,97,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TB GOLD QUANTIFERON,101295-4,CDM,300,RC,86480,CPT,,,,,BOTH,,,114,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RHEUMATIOD FACTOR,910813-5,CDM,300,RC,86431,CPT,,,,,BOTH,,,53,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MITOCHONDRIAL AB,99414-5,CDM,300,RC,86381,CPT,,,,,BOTH,,,25,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROID PEROXIDASE AB,99370-9,CDM,300,RC,86376,CPT,,,,,BOTH,,,130,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BERYLLIUM LYMPH PROL,101555-1,CDM,300,RC,86353,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRINSIC FACTOR,99540-7,CDM,300,RC,86340,CPT,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IF ELECTROPHORESIS 24 HR UR,99672-8,CDM,300,RC,86335,CPT,,,,,BOTH,,,271,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOFIXATION SERUM,99190-1,CDM,300,RC,86334,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TETANUS ANTIBODY,99523-3,CDM,300,RC,86317,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONO TEST,91046-3,CDM,300,RC,86308,CPT,,,,,BOTH,,,49,,,73,,4,3,4,18,percent of total billed charges,,,73,,4,3,4,18,percent of total billed charges,,,73,,4,3,4,18,percent of total billed charges,,,73,,4,3,4,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,3,3,1 through 10,percent of total billed charges,,,,
CA125,99149-7,CDM,300,RC,86304,CPT,,,,,BOTH,,,109,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CA 19-9,99040-8,CDM,300,RC,86301,CPT,,,,,BOTH,,,92,,,73,,14,14,17,13,percent of total billed charges,,,73,,14,14,17,13,percent of total billed charges,,,73,,14,14,17,13,percent of total billed charges,,,73,,14,14,17,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CA 15-3,99407-9,CDM,300,RC,86300,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CA 27.29,99307-1,CDM,300,RC,86300,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPLASMIC AB (C-ANCA),99652-0,CDM,300,RC,86255,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SKELETAL MUSCLE ANTIBODY,99349-3,CDM,300,RC,86255,CPT,,,,,BOTH,,,71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANCA,99394-9,CDM,300,RC,86255,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARIETAL CELL AB,99369-1,CDM,300,RC,86255,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEURONAL NUCLEAR AB,99534-0,CDM,300,RC,86255,CPT,,,,,BOTH,,,133,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JO-1 AB,99566-2,CDM,300,RC,86235,CPT,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RNP ANTIBODY,99476-4,CDM,300,RC,86235,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SM ANTIBODY,99477-2,CDM,300,RC,86235,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SS-A AB,99446-7,CDM,300,RC,86235,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SS-B AB,99449-1,CDM,300,RC,86235,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCLERODERMA PROFILE,99601-7,CDM,300,RC,86235,CPT,,,,,BOTH,,,108,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATYPICAL PNEUMONIA,99056-4,CDM,300,RC,86171,CPT,,,,,BOTH,,,379,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMPLEMENT (TOTAL),99347-7,CDM,300,RC,86162,CPT,,,,,BOTH,,,74,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C4,99299-0,CDM,300,RC,86160,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C3,99298-2,CDM,300,RC,86160,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHATICYLSERINE,99405-3,CDM,300,RC,86148,CPT,,,,,BOTH,,,366,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTICARDIOLIPIN AIGA,99424-4,CDM,300,RC,86147,CPT,,,,,BOTH,,,112,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTICARDIOLIPIN AIGM,99425-1,CDM,300,RC,86147,CPT,,,,,BOTH,,,112,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTICARDIOLIPIN ABIG,99486-3,CDM,300,RC,86147,CPT,,,,,BOTH,,,139,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C-REACTIVE PROTEIN,91097-6,CDM,300,RC,86140,CPT,,,,,BOTH,,,89,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
STREPTOZYME,99474-9,CDM,300,RC,86063,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASO ANTIBODY,910812-7,CDM,300,RC,86060,CPT,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASO SCREEN (TITER),91094-3,CDM,300,RC,86060,CPT,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANATITER & PATTERN,99560-5,CDM,300,RC,86039,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANA,91093-5,CDM,300,RC,86038,CPT,,,,,BOTH,,,84,,,73,,10,10,10,15,percent of total billed charges,,,73,,10,10,10,15,percent of total billed charges,,,73,,10,10,10,15,percent of total billed charges,,,73,,10,10,10,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERINUCLEAR AB P-ANC,99653-8,CDM,300,RC,86037,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET ANTIBODIES,99200-8,CDM,300,RC,86022,CPT,,,,,BOTH,,,293.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SMOOTH MUSCLE, AB",99368-3,CDM,300,RC,86015,CPT,,,,,BOTH,,,67,,,73,,3,3,3.7,1 through 10,percent of total billed charges,,,73,,3,3,3.7,1 through 10,percent of total billed charges,,,73,,3,3,3.7,1 through 10,percent of total billed charges,,,73,,3,3,3.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPHA GAL TOTAL,101538-7,CDM,300,RC,86008,CPT,,,,,BOTH,,,35.88,,,73,,17.5,35,35,1 through 10,percent of total billed charges,,,73,,17.5,35,35,1 through 10,percent of total billed charges,,,73,,17.5,35,35,1 through 10,percent of total billed charges,,,73,,17.5,35,35,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,13,13,13,1 through 10,percent of total billed charges,,,,
ALPHA GAL BEEF,101539-5,CDM,300,RC,86003,CPT,,,,,BOTH,,,35.88,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALPHA GAL LAMB,101540-3,CDM,300,RC,86003,CPT,,,,,BOTH,,,35.88,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALPHA GAL PORK,101541-1,CDM,300,RC,86003,CPT,,,,,BOTH,,,35.88,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PROTEUS OX 19,99616-5,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEUS OX 2,99615-7,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEUS OX K,99617-3,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALMONELLA H GP A,99618-1,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALMONELLA H GP B,99619-9,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALMONELLA H GP D,99668-6,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALMONELLA O GP D,99621-5,CDM,300,RC,86000,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PTT SUBST PLAMA FRACTION,99467-3,CDM,300,RC,85732,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APTT 1 HR PT CONTROL,99643-9,CDM,300,RC,85732,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APTT 1:1 NP,99641-3,CDM,300,RC,85732,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APTT 1 HR INCUB1:1NP,99642-1,CDM,300,RC,85732,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PART-THROMBOPLASTIN,91047-1,CDM,300,RC,85730,CPT,,,,,BOTH,,,36,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,3,3,1 through 10,percent of total billed charges,,,,
PTT REPEAT,99551-4,CDM,300,RC,85730,CPT,,,91,,BOTH,,,36,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,73,,5,4.8,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,3,3,1 through 10,percent of total billed charges,,,,
THROMBIN TIME,99640-5,CDM,300,RC,85670,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUSSELL VIPER VENOM TIME-DILUTED,99639-7,CDM,300,RC,85613,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTIME COAG CHEK,365-7,CDM,300,RC,85610,CPT,,,QW,,BOTH,,,13.4,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
PROTIME COAG CHEK,212-1,CDM,300,RC,85610,CPT,,,QW,,BOTH,,,13.4,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
PT REPEAT,99550-6,CDM,300,RC,85610,CPT,,,91,,BOTH,,,53,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
PT(PROTIME),91010-9,CDM,300,RC,85610,CPT,,,,,BOTH,,,53,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
PLATELET NEUTRALIZATION,99483-0,CDM,300,RC,85597,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACID HEMOLYSIS TEST,99535-7,CDM,300,RC,85475,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBRINOGEN QN,99226-3,CDM,300,RC,85384,CPT,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D-DIMER,99491-3,CDM,300,RC,85379,CPT,,,,,BOTH,,,229,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
D-DIMER REPEAT,101516-3,CDM,300,RC,85379,CPT,,,91,,BOTH,,,229,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,73,,8,6,8,30,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CLOTTING TIME,91187-5,CDM,300,RC,85348,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN S,99246-1,CDM,300,RC,85306,CPT,,,,,BOTH,,,286,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN C,99245-3,CDM,300,RC,85303,CPT,,,,,BOTH,,,274,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTITHROMBIN III,99275-0,CDM,300,RC,85300,CPT,,,,,BOTH,,,65,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR XIII,99389-9,CDM,300,RC,85291,CPT,,,,,BOTH,,,156,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR X,99390-7,CDM,300,RC,85260,CPT,,,,,BOTH,,,230,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR IX,99387-3,CDM,300,RC,85250,CPT,,,,,BOTH,,,230,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VONWILLEBRAND MULTIMERIC,99699-1,CDM,300,RC,85247,CPT,,,,,BOTH,,,224,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WILLEBRAND MULTIMETRIC ANALYSIS,99372-5,CDM,300,RC,85247,CPT,,,,,BOTH,,,295,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VWF ANTIGEN,99696-7,CDM,300,RC,85246,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VWF ACTIVITY,99695-9,CDM,300,RC,85245,CPT,,,,,BOTH,,,167,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISTOCETIN COFACTOR (WF ACT),99371-7,CDM,300,RC,85245,CPT,,,,,BOTH,,,240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR VIII ACTIVITY,99363-4,CDM,300,RC,85240,CPT,,,,,BOTH,,,240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR V,99318-8,CDM,300,RC,85220,CPT,,,,,BOTH,,,240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR II ACTIVITY,99600-9,CDM,300,RC,85210,CPT,,,,,BOTH,,,290,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WHITE BLOOD CELL COUNT-REPEAT,99922-7,CDM,300,RC,85048,CPT,,,91,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WHITE BLOOD COUNT,91063-8,CDM,300,RC,85048,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RETICULOCYTE SEND-OUT,99450-9,CDM,300,RC,85045,CPT,,,,,BOTH,,,42,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,3,3,1 through 10,percent of total billed charges,,,,
HBG REPEAT,99562-1,CDM,300,RC,85018,CPT,,,91,,BOTH,,,11,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOGLOBIN-REPEAT,99783-3,CDM,300,RC,85018,CPT,,,91,,BOTH,,,11,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HGB(HEMOGLOBIN),91013-3,CDM,300,RC,85018,CPT,,,,,BOTH,,,11,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCT REPEAT,99563-9,CDM,300,RC,85014,CPT,,,91,,BOTH,,,11,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCT(HEMATOCRIT),90014-2,CDM,300,RC,85014,CPT,,,,,BOTH,,,11,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLEEDING TIME,91183-4,CDM,300,RC,85002,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCG SERUM REPEAT,101146-9,CDM,300,RC,84703,CPT,,,91,,BOTH,,,77,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
HCG (SERUM),91109-9,CDM,300,RC,84703,CPT,,,,,BOTH,,,92,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,73,,6,4,6,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
CHORIONIE GONODOTROPIN TUMOR MARKER,99345-1,CDM,300,RC,84702,CPT,,,,,BOTH,,,66,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"HCG, QUANTITATIVE",91095-0,CDM,300,RC,84702,CPT,,,,,BOTH,,,140,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C-PEPTIDE,99415-2,CDM,300,RC,84681,CPT,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC,99459-0,CDM,300,RC,84630,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISOPROPYL ALCOHOL,90044-9,CDM,300,RC,84600,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITKI,99597-7,CDM,300,RC,84597,CPT,,,,,BOTH,,,433,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VM ACID URINE,91150-3,CDM,300,RC,84585,CPT,,,,,BOTH,,,155,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URIC ACID FLUID,99285-9,CDM,300,RC,84560,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE URIC ACID,91242-8,CDM,300,RC,84560,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URIC ACID BLOOD,91062-0,CDM,300,RC,84550,CPT,,,,,BOTH,,,28,,,73,,3,3,3,13,percent of total billed charges,,,73,,3,3,3,13,percent of total billed charges,,,73,,3,3,3,13,percent of total billed charges,,,73,,3,3,3,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,3,3,1 through 10,percent of total billed charges,,,,
UREA NITROGEN (U) RANDOM,99445-9,CDM,300,RC,84540,CPT,,,,,BOTH,,,26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUN,90019-1,CDM,300,RC,84520,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T3 FREE,99410-3,CDM,300,RC,84481,CPT,,,,,BOTH,,,54,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-3 UPTAKE,99337-8,CDM,300,RC,84479,CPT,,,,,BOTH,,,30,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIGLYCERIDES,91149-5,CDM,300,RC,84478,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSFERRIN,91148-7,CDM,300,RC,84466,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SGPT,90037-3,CDM,300,RC,84460,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SGOT,91036-4,CDM,300,RC,84450,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROID STIMULATING IMMUNOGLOBULIN,99504-3,CDM,300,RC,84445,CPT,,,,,BOTH,,,278,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TSH,91143-8,CDM,300,RC,84443,CPT,,,,,BOTH,,,77,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,12,11,13,15,percent of total billed charges,,,,
T4 FREE,91142-0,CDM,300,RC,84439,CPT,,,,,BOTH,,,55,,,73,,7,5,7,117,percent of total billed charges,,,73,,7,5,7,117,percent of total billed charges,,,73,,7,5,7,117,percent of total billed charges,,,73,,7,5,7,117,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5,7,1 through 10,percent of total billed charges,,,,
T4 RIA,191242-7,CDM,300,RC,84436,CPT,,,,,BOTH,,,32,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B1,99416-0,CDM,300,RC,84425,CPT,,,,,BOTH,,,154,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TESTOSTERONE,91144-6,CDM,300,RC,84403,CPT,,,,,BOTH,,,138,,,73,,17,1,19.5,1 through 10,percent of total billed charges,,,73,,17,1,19.5,1 through 10,percent of total billed charges,,,73,,17,1,19.5,1 through 10,percent of total billed charges,,,73,,17,1,19.5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,19,19,19,1 through 10,percent of total billed charges,,,,
PHOSPHOLIPIDS,99381-6,CDM,300,RC,84311,CPT,,,,,BOTH,,,59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PORPHYRIN,99612-4,CDM,300,RC,84311,CPT,,,,,BOTH,,,161,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSULIN-LIKE GROWTH FACTOR I,99675-1,CDM,300,RC,84305,CPT,,,,,BOTH,,,318,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SODIUM, RANDOM URINE",99443-4,CDM,300,RC,84300,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE SODIUM,91191-7,CDM,300,RC,84300,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NA(SODIUM),91198-2,CDM,300,RC,84295,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEX HORMONE BINDING GLOBLIN,99533-2,CDM,300,RC,84270,CPT,,,,,BOTH,,,119,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B6,99350-1,CDM,300,RC,84207,CPT,,,,,BOTH,,,284,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROINSULIN,99485-5,CDM,300,RC,84206,CPT,,,,,BOTH,,,336,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTOPORPHYRIN FREE ERYTHROCYTE,99505-0,CDM,300,RC,84202,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN ELECTRO (UR),99124-0,CDM,300,RC,84166,CPT,,,,,BOTH,,,155,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ELECTROPHORETIC F FL,99671-0,CDM,300,RC,84166,CPT,,,,,BOTH,,,271,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN ELECTR (U) RANDOM,99453-3,CDM,300,RC,84165,CPT,,,,,BOTH,,,59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT ELECTRO SERUM,91120-6,CDM,300,RC,84165,CPT,,,,,BOTH,,,113,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN BDY FLUID,99398-0,CDM,300,RC,84157,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN TOTAL (U)RANDOM,99452-5,CDM,300,RC,84156,CPT,,,,,BOTH,,,20,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
24 HR PROTEIN URINE,91219-6,CDM,300,RC,84156,CPT,,,,,BOTH,,,96,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN TOTAL,91073-7,CDM,300,RC,84155,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSA FREE,99583-7,CDM,300,RC,84154,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PROSTATIC,SP ANTIGEN",91339-2,CDM,300,RC,84153,CPT,,,,,BOTH,,,110,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,15,15,15,1 through 10,percent of total billed charges,,,,
PROLACTIN,91284-0,CDM,300,RC,84146,CPT,,,,,BOTH,,,110,,,73,,142,142,142,1 through 10,percent of total billed charges,,,73,,142,142,142,1 through 10,percent of total billed charges,,,73,,142,142,142,1 through 10,percent of total billed charges,,,73,,142,142,142,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROGESTRONE,91340-0,CDM,300,RC,84144,CPT,,,,,BOTH,,,110,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,73,,17,17,17,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE POTASSIUM,99423-6,CDM,300,RC,84133,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K (POTASSIUM) REPEAT,99764-3,CDM,300,RC,84132,CPT,,,91,,BOTH,,,28,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
K(POTASSIUM),91199-0,CDM,300,RC,84132,CPT,,,,,BOTH,,,28,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PORPHYRINS FR U,99413-7,CDM,300,RC,84120,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PORPHOBILINOGEN Q UR RANDOM,88611-9,CDM,300,RC,84110,CPT,,,,,BOTH,,,120,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHORUS INORGANIC U,99435-0,CDM,300,RC,84105,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHORUS,91072-9,CDM,300,RC,84100,CPT,,,,,BOTH,,,28,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHORUS - REPEAT,99969-8,CDM,300,RC,84100,CPT,,,91,,BOTH,,,28,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALK PHOS ISO ENZYMES,99536-5,CDM,300,RC,84080,CPT,,,,,BOTH,,,82,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACID PO4 (PROSTATIC),91088-5,CDM,300,RC,84066,CPT,,,,,BOTH,,,157,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACID PHOS (TOTAL),99378-2,CDM,300,RC,84060,CPT,,,,,BOTH,,,53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PH SEND-OUT,99496-2,CDM,300,RC,83986,CPT,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PTH INTACT,99386-5,CDM,300,RC,83970,CPT,,,,,BOTH,,,83,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PTH C TERMINAL,99384-0,CDM,300,RC,83970,CPT,,,,,BOTH,,,95,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PTH N TERMINAL,99385-7,CDM,300,RC,83970,CPT,,,,,BOTH,,,98,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARATHYROID HORMONE,91208-9,CDM,300,RC,83970,CPT,,,,,BOTH,,,220,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,73,,35,35,35,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXALATE 24 HR URINE,99353-5,CDM,300,RC,83945,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSMALALITY (URINE),99170-3,CDM,300,RC,83935,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSMOLALITY (SERUM),99169-5,CDM,300,RC,83930,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE-URINE CONF,99701-5,CDM,300,RC,83925,CPT,,,,,BOTH,,,41.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLAMALONIC ACID,99316-2,CDM,300,RC,83921,CPT,,,,,BOTH,,,282,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANIC ACID/URINE,99292-5,CDM,300,RC,83919,CPT,,,,,BOTH,,,253,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLIGOCLONAL BANDING (CSF),99396-4,CDM,300,RC,83916,CPT,,,,,BOTH,,,68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APOLIPOPROTEIN E GEN,99360-0,CDM,300,RC,83898,CPT,,,,,BOTH,,,382,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BNP REPEAT,99830-2,CDM,300,RC,83880,CPT,,,91,,BOTH,,,94,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRO-BNP,99581-1,CDM,300,RC,83880,CPT,,,,,BOTH,,,94,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,73,,20,20,27.2,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYOGLOBIN,99432-7,CDM,300,RC,83874,CPT,,,,,BOTH,,,56,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYOGLOBIN REPEAT,99543-1,CDM,300,RC,83874,CPT,,,91,,BOTH,,,56,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYOGLOBIN (U),99171-1,CDM,300,RC,83874,CPT,,,,,BOTH,,,73,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYELIN BASIC PROTEIN,99577-9,CDM,300,RC,83873,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METANEPHRINES FRACTIONATED,99359-2,CDM,300,RC,83835,CPT,,,,,BOTH,,,114,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UR TOT METANEPHRINES,91261-8,CDM,300,RC,83835,CPT,,,,,BOTH,,,124,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METANEPHRINES,99254-5,CDM,300,RC,83835,CPT,,,,,BOTH,,,168,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MERCURY,99506-8,CDM,300,RC,83825,CPT,,,,,BOTH,,,89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNESIUM U,99404-6,CDM,300,RC,83735,CPT,,,,,BOTH,,,37,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4,5,17,percent of total billed charges,,,,
MAGNESIUM,99113-3,CDM,300,RC,83735,CPT,,,,,BOTH,,,44,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4,5,17,percent of total billed charges,,,,
MAGNESIUM - REPEAT,99970-6,CDM,300,RC,83735,CPT,,,91,,BOTH,,,44,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4,5,17,percent of total billed charges,,,,
MAGNESIUM - REPEAT,101041-2,CDM,300,RC,83735,CPT,,,91,,BOTH,,,44,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,73,,5,4,5,218,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4,5,17,percent of total billed charges,,,,
DIRECT LDL,99412-9,CDM,300,RC,83721,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIPOPROTEIN (A),99557-1,CDM,300,RC,83695,CPT,,,,,BOTH,,,142,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEAD,91214-7,CDM,300,RC,83655,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTOFERRIN,101537-9,CDM,300,RC,83631,CPT,,,,,BOTH,,,142.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LDH ISOENZYMES,91185-9,CDM,300,RC,83625,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LDH,91016-6,CDM,300,RC,83615,CPT,,,,,BOTH,,,46,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LDH REPEAT,99541-5,CDM,300,RC,83615,CPT,,,91,,BOTH,,,46,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTIC ACID,99045-7,CDM,300,RC,83605,CPT,,,,,BOTH,,,30,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IRON BINDING CAP.,91131-3,CDM,300,RC,83550,CPT,,,,,BOTH,,,138,,,73,,7,5,7,39,percent of total billed charges,,,73,,7,5,7,39,percent of total billed charges,,,73,,7,5,7,39,percent of total billed charges,,,73,,7,5,7,39,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5.2,6.8,1 through 10,percent of total billed charges,,,,
IRON,91266-7,CDM,300,RC,83540,CPT,,,,,BOTH,,,76,,,73,,5,3.3,5,40,percent of total billed charges,,,73,,5,3.3,5,40,percent of total billed charges,,,73,,5,3.3,5,40,percent of total billed charges,,,73,,5,3.3,5,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4.5,4.1,4.9,1 through 10,percent of total billed charges,,,,
INSULIN,99406-1,CDM,300,RC,83525,CPT,,,,,BOTH,,,55,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETYLCHOLINE RECPT,99282-6,CDM,300,RC,83519,CPT,,,,,BOTH,,,540,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
17 ALPHA HYDROXYPROGESTERONE,99613-2,CDM,300,RC,83498,CPT,,,,,BOTH,,,190,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIAA,99499-6,CDM,300,RC,83497,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HOMOCYSTEINE (CARDIO),99392-3,CDM,300,RC,83090,CPT,,,,,BOTH,,,82,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,73,,14,14,14,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOSIDERIN STAIN (URINE),99403-8,CDM,300,RC,83070,CPT,,,,,BOTH,,,53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOGLOBIN (PLASMA),99400-4,CDM,300,RC,83051,CPT,,,,,BOTH,,,61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCOHEMOGLOBIN,91233-7,CDM,300,RC,83036,CPT,,,,,BOTH,,,116,,,73,,8,6,8,149,percent of total billed charges,,,73,,8,6,8,149,percent of total billed charges,,,73,,8,6,8,149,percent of total billed charges,,,73,,8,6,8,149,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,6,7,18,percent of total billed charges,,,,
HGB ELECTROPHORESIS,99498-8,CDM,300,RC,83020,CPT,,,,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOGLOBIN,110-7,CDM,300,RC,83020,CPT,,,QW,,BOTH,,,276,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOGLOBIN,327-7,CDM,300,RC,83020,CPT,,,QW,,BOTH,,,276,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAPTOGLOBIN,91127-1,CDM,300,RC,83010,CPT,,,,,BOTH,,,160,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,10,10,1 through 10,percent of total billed charges,,,,
HUMAN GROWTH HORMONE,99408-7,CDM,300,RC,83003,CPT,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LH,99236-2,CDM,300,RC,83002,CPT,,,,,BOTH,,,94,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FSH,91320-2,CDM,300,RC,83001,CPT,,,,,BOTH,,,110,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,73,,15,15,15,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FRUCTOSAMINE,99587-8,CDM,300,RC,82985,CPT,,,,,BOTH,,,84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GGT,99110-9,CDM,300,RC,82977,CPT,,,,,BOTH,,,38,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GGT - REPEAT,99971-4,CDM,300,RC,82977,CPT,,,91,,BOTH,,,38,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE TOL EA ADDITION,99466-5,CDM,300,RC,82952,CPT,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GTT (3RD HOUR),90039-9,CDM,300,RC,82952,CPT,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GTT (4TH HOUR),91040-6,CDM,300,RC,82952,CPT,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GTT (5TH HOUR),910401-9,CDM,300,RC,82952,CPT,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GTT (6TH HOUR),910402-7,CDM,300,RC,82952,CPT,,,,,BOTH,,,17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE TOL 3 SPEC,99470-7,CDM,300,RC,82951,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GTT UP TO 2 HOURS,91039-8,CDM,300,RC,82951,CPT,,,,,BOTH,,,97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE ACCUCHECK,104-0,CDM,300,RC,82948,CPT,,,QW,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE ACCUCHECK,305-3,CDM,300,RC,82948,CPT,,,QW,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE,91203-0,CDM,300,RC,82947,CPT,,,,,BOTH,,,18,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE - REPEAT,82764-2,CDM,300,RC,82947,CPT,,,91,,BOTH,,,18,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,73,,2,2,2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCOSE BDY FLUID,99397-2,CDM,300,RC,82945,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCAGON,101453-9,CDM,300,RC,82943,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GASTRIN,99238-8,CDM,300,RC,82941,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ABG ANALYSIS,60027-0,CDM,300,RC,82803,CPT,,,,,BOTH,,,252,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
O2 SAT,326-9,CDM,300,RC,82803,CPT,,,QW,,BOTH,,,316,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
O2 SAT,207-1,CDM,300,RC,82803,CPT,,,QW,,BOTH,,,316,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD GAS PH ONLY,60102-1,CDM,300,RC,82800,CPT,,,,,BOTH,,,210,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGE,99019-2,CDM,300,RC,82785,CPT,,,,,BOTH,,,170,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,13,13,13,1 through 10,percent of total billed charges,,,,
IGG CSF,99572-0,CDM,300,RC,82784,CPT,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG,99332-9,CDM,300,RC,82784,CPT,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGM,99333-7,CDM,300,RC,82784,CPT,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGA,91280-8,CDM,300,RC,82784,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RBC FOLATE,99025-9,CDM,300,RC,82747,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOLATE (RIA),91124-8,CDM,300,RC,82746,CPT,,,,,BOTH,,,92,,,73,,12,9,98,42,percent of total billed charges,,,73,,12,9,98,42,percent of total billed charges,,,73,,12,9,98,42,percent of total billed charges,,,73,,12,9,98,42,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,12,12,12,1 through 10,percent of total billed charges,,,,
FERRITIN,91122-2,CDM,300,RC,82728,CPT,,,,,BOTH,,,92,,,73,,11,7.2,11,35,percent of total billed charges,,,73,,11,7.2,11,35,percent of total billed charges,,,73,,11,7.2,11,35,percent of total billed charges,,,73,,11,7.2,11,35,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,11,11,11,1 through 10,percent of total billed charges,,,,
"FECAL FAT, QUAL",99308-9,CDM,300,RC,82705,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETHYLENE GLYCOL,99487-1,CDM,300,RC,82693,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRIOL,99674-4,CDM,300,RC,82677,CPT,,,,,BOTH,,,162,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL,99340-2,CDM,300,RC,82670,CPT,,,,,BOTH,,,84,,,73,,23,23,23,1 through 10,percent of total billed charges,,,73,,23,23,23,1 through 10,percent of total billed charges,,,73,,23,23,23,1 through 10,percent of total billed charges,,,73,,23,23,23,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROPOIETIN,99358-4,CDM,300,RC,82668,CPT,,,,,BOTH,,,187,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 1.25 DIHYDROXY,99673-6,CDM,300,RC,82652,CPT,,,,,BOTH,,,419,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B12,91153-7,CDM,300,RC,82607,CPT,,,,,BOTH,,,92,,,73,,12,3.9,12,94,percent of total billed charges,,,73,,12,3.9,12,94,percent of total billed charges,,,73,,12,3.9,12,94,percent of total billed charges,,,73,,12,3.9,12,94,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,12,8.6,12,1 through 10,percent of total billed charges,,,,
CRYOGLOBULIN,99325-3,CDM,300,RC,82595,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREATININE CLEARANCE,91226-1,CDM,300,RC,82575,CPT,,,,,BOTH,,,133,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREATININE URINE,99442-6,CDM,300,RC,82570,CPT,,,,,BOTH,,,23,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CREATININE,91204-8,CDM,300,RC,82565,CPT,,,,,BOTH,,,35,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREATININE REPEAT,101522-1,CDM,300,RC,82565,CPT,,,91,,BOTH,,,35,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MB,99433-5,CDM,300,RC,82553,CPT,,,,,BOTH,,,29,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
MB REPEAT,99542-3,CDM,300,RC,82553,CPT,,,91,,BOTH,,,29,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
ISOENZYMES,99677-7,CDM,300,RC,82552,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CPK INSOENZYMES,91184-2,CDM,300,RC,82552,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CPK,91015-8,CDM,300,RC,82550,CPT,,,,,BOTH,,,32,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,26.6,1 through 10,percent of total billed charges,,,,
CPK REPEAT,99539-9,CDM,300,RC,82550,CPT,,,91,,BOTH,,,32,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,73,,4,4,5,69,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,26.6,1 through 10,percent of total billed charges,,,,
CORTISOL,91110-7,CDM,300,RC,82533,CPT,,,,,BOTH,,,92,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CORTISOL, URINE (FREE)",99321-2,CDM,300,RC,82530,CPT,,,,,BOTH,,,161,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COPPER,99338-6,CDM,300,RC,82525,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CITRATE 24 HR URINE,99354-3,CDM,300,RC,82507,CPT,,,,,BOTH,,,287,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOLINESTERASE,99463-2,CDM,300,RC,82480,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOLESTEROL (TOTAL),91107-3,CDM,300,RC,82465,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CHLORIDE, RANDOM URINE",99444-2,CDM,300,RC,82436,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE CHLORIDE,99422-8,CDM,300,RC,82436,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CL (CHLORIDE),91200-6,CDM,300,RC,82435,CPT,,,,,BOTH,,,31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CERULOPLASMIN,99320-4,CDM,300,RC,82390,CPT,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UR CATECHOLAMINES,91260-0,CDM,300,RC,82384,CPT,,,,,BOTH,,,124,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATECHOLAMINES-FRACT,91104-0,CDM,300,RC,82384,CPT,,,,,BOTH,,,298,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAROTENE,99530-8,CDM,300,RC,82380,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEA,91103-2,CDM,300,RC,82378,CPT,,,,,BOTH,,,110,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARBOXYHEMOGLOBIN LV,99046-5,CDM,300,RC,82375,CPT,,,,,BOTH,,,30.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CO2(CARBON DIOXIDE),91201-4,CDM,300,RC,82374,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CALCIUM, 24 HR URINE",99352-7,CDM,300,RC,82340,CPT,,,,,BOTH,,,52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM IONIZED,99522-5,CDM,300,RC,82330,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM,91071-1,CDM,300,RC,82310,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM-REPEAT,99815-3,CDM,300,RC,82310,CPT,,,91,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCITONIN,99377-4,CDM,300,RC,82308,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D 25-HYDROXY,99598-5,CDM,300,RC,82306,CPT,,,,,BOTH,,,44,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,24,18.5,24,1 through 10,percent of total billed charges,,,,
OCCULT BLOOD,322-8,CDM,300,RC,82270,CPT,,,QW,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OCCULT BLOOD,170-1,CDM,300,RC,82270,CPT,,,QW,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIRECT BILIRUBIN,91027-3,CDM,300,RC,82248,CPT,,,,,BOTH,,,28,,,73,,3,3,4,32,percent of total billed charges,,,73,,3,3,4,32,percent of total billed charges,,,73,,3,3,4,32,percent of total billed charges,,,73,,3,3,4,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,3,2.2,3.8,1 through 10,percent of total billed charges,,,,
TOTAL BILIRUBIN,91026-5,CDM,300,RC,82247,CPT,,,,,BOTH,,,28,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BILE ACIDS,101536-1,CDM,300,RC,82239,CPT,,,,,BOTH,,,52.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETA-2-MICROGLOBULIN,99328-7,CDM,300,RC,82232,CPT,,,,,BOTH,,,70,,,73,,112,112,112,1 through 10,percent of total billed charges,,,73,,112,112,112,1 through 10,percent of total billed charges,,,73,,112,112,112,1 through 10,percent of total billed charges,,,73,,112,112,112,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARSENIC,99507-6,CDM,300,RC,82175,CPT,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARSENIC HAIR,101739-1,CDM,300,RC,82175,CPT,,,,,BOTH,,,241.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANGIOTENSIN-1-CON EN,99383-2,CDM,300,RC,82164,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMYLASE,91023-2,CDM,300,RC,82150,CPT,,,,,BOTH,,,34,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4.2,28.2,1 through 10,percent of total billed charges,,,,
AMYLASE REPEAT,101043-8,CDM,300,RC,82150,CPT,,,91,,BOTH,,,34,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,73,,5,4,5,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4.2,28.2,1 through 10,percent of total billed charges,,,,
AMMONIA,91092-7,CDM,300,RC,82140,CPT,,,,,BOTH,,,142,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMINO ACID/RANDOM UR,99291-7,CDM,300,RC,82139,CPT,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMINO ACIDS/PLASMA,99295-8,CDM,300,RC,82139,CPT,,,,,BOTH,,,716,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALUMINUM,99329-5,CDM,300,RC,82108,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFP WITH AFP-L3%,101511-4,CDM,300,RC,82107,CPT,,,,,BOTH,,,174.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPHA FETO PROTEIN,99023-4,CDM,300,RC,82105,CPT,,,,,BOTH,,,136,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPHA 1 ANTITRYPSIN,99457-4,CDM,300,RC,82103,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALDOSTERONE,99420-2,CDM,300,RC,82088,CPT,,,,,BOTH,,,187,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALDOLASE,91220-4,CDM,300,RC,82085,CPT,,,,,BOTH,,,109,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALCOHOL BLOOD-REPEAT,99836-9,CDM,300,RC,82077,CPT,,,91,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD ALCOHOL,91089-3,CDM,300,RC,82077,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BREATHALIZER IN HOUSE,99276-8,CDM,300,RC,82075,CPT,,,,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BREATHALYZER - REPEAT,99908-6,CDM,300,RC,82075,CPT,,,91,,BOTH,,,55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICROALBUMIN,99317-0,CDM,300,RC,82043,CPT,,,,,BOTH,,,67,,,73,,4,4,4,55,percent of total billed charges,,,73,,4,4,4,55,percent of total billed charges,,,73,,4,4,4,55,percent of total billed charges,,,73,,4,4,4,55,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALBUMIN CSF,99571-2,CDM,300,RC,82042,CPT,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUMIN,91074-5,CDM,300,RC,82040,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUMIN REPEAT,101543-7,CDM,300,RC,82040,CPT,,,91,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACTH,99272-7,CDM,300,RC,82024,CPT,,,,,BOTH,,,140,,,73,,28,28,28,1 through 10,percent of total billed charges,,,73,,28,28,28,1 through 10,percent of total billed charges,,,73,,28,28,28,1 through 10,percent of total billed charges,,,73,,28,28,28,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETONE,99290-9,CDM,300,RC,82010,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC HLA DQ 2,101736-7,CDM,300,RC,81377,CPT,,,,,BOTH,,,236.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC HLA DQ 8,101737-5,CDM,300,RC,81377,CPT,,,,,BOTH,,,236.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HLA B27,91293-1,CDM,300,RC,81374,CPT,,,,,BOTH,,,119,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MTHFR,101317-6,CDM,300,RC,81291,CPT,,,,,BOTH,,,250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JAK2,101405-9,CDM,300,RC,81270,CPT,,,,,BOTH,,,467,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERED HEMOCHROMATOSI,101284-8,CDM,300,RC,81256,CPT,,,,,BOTH,,,350,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOPIDOGREL,101427-3,CDM,300,RC,81255,CPT,,,,,BOTH,,,583.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR V LEIDEN,99374-1,CDM,300,RC,81241,CPT,,,,,BOTH,,,346,,,73,,173,346,346,1 through 10,percent of total billed charges,,,73,,173,346,346,1 through 10,percent of total billed charges,,,73,,173,346,346,1 through 10,percent of total billed charges,,,73,,173,346,346,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR II DNA,101318-4,CDM,300,RC,81240,CPT,,,,,BOTH,,,308.1,,,73,,308,308,308,1 through 10,percent of total billed charges,,,73,,308,308,308,1 through 10,percent of total billed charges,,,73,,308,308,308,1 through 10,percent of total billed charges,,,73,,308,308,308,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME RFX MICR,101451-3,CDM,300,RC,81229,CPT,,,,,BOTH,,,2100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME RFX MICRO,101446-3,CDM,300,RC,81229,CPT,,,,,BOTH,,,2100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE VOLUME MEASUREMENT,99492-1,CDM,300,RC,81050,CPT,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINE PREGNANCY TEST,91012-5,CDM,300,RC,81025,CPT,,,,,BOTH,,,49,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGNANCY TEST,142-0,CDM,300,RC,81025,CPT,,,QW,,BOTH,,,80,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGNANCY TEST,334-3,CDM,300,RC,81025,CPT,,,QW,,BOTH,,,80,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,73,,25,5.8,44.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UA/ MICRO,191189-0,CDM,300,RC,81015,CPT,,,,,BOTH,,,25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REDUCING SUBSTANCE/URINE,99293-3,CDM,300,RC,81005,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
URINALYSIS,99740-3,CDM,300,RC,81003,CPT,,,QW,,BOTH,,,7,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINE PH,101220-2,CDM,300,RC,81003,CPT,,,,,BOTH,,,7,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINE PH REPEAT,101417-4,CDM,300,RC,81003,CPT,,,91,,BOTH,,,7,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINE DIPSTICK AUTO,94438-9,CDM,300,RC,81003,CPT,,,QW,,BOTH,,,10,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINE SP GRAVITY,99493-9,CDM,300,RC,81003,CPT,,,,,BOTH,,,12,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINALYSIS DIPSTICK,103-2,CDM,300,RC,81003,CPT,,,QW,,BOTH,,,42,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINALYSIS DIPSTICK,300-4,CDM,300,RC,81003,CPT,,,QW,,BOTH,,,42,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
BEL PATH CONSULT,101556-9,CDM,300,RC,80500,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE CONF UR,101002-4,CDM,300,RC,80365,CPT,,,,,BOTH,,,75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OPIATE CONFIRM URINE,99594-4,CDM,300,RC,80361,CPT,,,,,BOTH,,,90,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHADONE CONF URINE,99589-4,CDM,300,RC,80358,CPT,,,,,BOTH,,,90,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHADONE SERUM,99265-1,CDM,300,RC,80358,CPT,,,,,BOTH,,,138,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OPIATES BLOOD PANEL,99906-0,CDM,300,RC,80356,CPT,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCAINE CONF URINE,99603-3,CDM,300,RC,80353,CPT,,,,,BOTH,,,36.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCAINE SERUM,99356-8,CDM,300,RC,80353,CPT,,,,,BOTH,,,282,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANNABINOID UR CONF,99679-3,CDM,300,RC,80349,CPT,,,,,BOTH,,,77.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPRENORPHINE CONF,99885-6,CDM,300,RC,80348,CPT,,,,,BOTH,,,127,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZO CONFIRM URINE,99588-6,CDM,300,RC,80346,CPT,,,,,BOTH,,,90,,,73,,39.5,79,79,1 through 10,percent of total billed charges,,,73,,39.5,79,79,1 through 10,percent of total billed charges,,,73,,39.5,79,79,1 through 10,percent of total billed charges,,,73,,39.5,79,79,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARBITURATE CONFIRM,99759-3,CDM,300,RC,80345,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PERAMPANEL/FYCOMPA,101548-6,CDM,300,RC,80339,CPT,,,,,BOTH,,,213,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIDEPRESSANTS NOS,101751-6,CDM,300,RC,80338,CPT,,,,,BOTH,,,40,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIDEP SEROTONERG6+,101750-8,CDM,300,RC,80334,CPT,,,,,BOTH,,,40,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALICYLATE REPEAT,101411-7,CDM,300,RC,80329,CPT,,,91,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN-REPEAT,99784-1,CDM,300,RC,80329,CPT,,,91,,BOTH,,,155,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICOTINE SERUM,99421-0,CDM,300,RC,80323,CPT,,,,,BOTH,,,109,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEXAR URINE DRUG CON,101677-3,CDM,300,RC,80307,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL QUAL,101753-2,CDM,300,RC,80307,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL SCR UR IA,101678-1,CDM,300,RC,80307,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL BLD 10 DR,101261-6,CDM,300,RC,80307,CPT,,,,,BOTH,,,370,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG SCREEN,101-6,CDM,300,RC,80305,CPT,,,QW,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG SCREEN,350-9,CDM,300,RC,80305,CPT,,,QW,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANNABINOID BLOOD,99806-2,CDM,300,RC,80301,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONAZEPAM (KLONOPIN,99997-9,CDM,300,RC,80299,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPHETAMINE BLOOD,99901-1,CDM,300,RC,80299,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOXEPIN,99322-0,CDM,300,RC,80299,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASONE,101500-7,CDM,300,RC,80299,CPT,,,,,BOTH,,,77.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM,99266-9,CDM,300,RC,80299,CPT,,,,,BOTH,,,88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGITOXIN,99168-7,CDM,300,RC,80299,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMITRIPTYLINE,99247-9,CDM,300,RC,80299,CPT,,,,,BOTH,,,96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SALICYLATE LEVEL,91232-9,CDM,300,RC,80299,CPT,,,,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOXETINE,99339-4,CDM,300,RC,80299,CPT,,,,,BOTH,,,145,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN,91086-9,CDM,300,RC,80299,CPT,,,,,BOTH,,,155,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGITALIS,99141-4,CDM,300,RC,80299,CPT,,,,,BOTH,,,161,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEBARAL,91135-4,CDM,300,RC,80299,CPT,,,,,BOTH,,,161,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPRAZOLAM LEVEL,101039-6,CDM,300,RC,80299,CPT,,,,,BOTH,,,167,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINE,99379-0,CDM,300,RC,80299,CPT,,,,,BOTH,,,210,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLONIDINE,99489-7,CDM,300,RC,80299,CPT,,,,,BOTH,,,558,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN PEAK,99043-2,CDM,300,RC,80202,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN RANDOM,82766-7,CDM,300,RC,80202,CPT,,,91,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN TROUGH,101642-7,CDM,300,RC,80202,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOPIRAMATE (TOPAMAX),99599-3,CDM,300,RC,80201,CPT,,,,,BOTH,,,200,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN - REPEAT,99868-2,CDM,300,RC,80200,CPT,,,91,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN RANDOM,99319-6,CDM,300,RC,80200,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMINOPHYLLINE(THEOPH,91091-9,CDM,300,RC,80198,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THEOPHYLLINE - REPEAT,99972-2,CDM,300,RC,80198,CPT,,,91,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACROLIMUS,99833-6,CDM,300,RC,80197,CPT,,,,,BOTH,,,319,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUINIDINE,91138-8,CDM,300,RC,80194,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCAINAMIDE,99067-1,CDM,300,RC,80192,CPT,,,,,BOTH,,,150,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAPA LEVEL,99038-2,CDM,300,RC,80192,CPT,,,,,BOTH,,,187,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMIDONE,101428-1,CDM,300,RC,80188,CPT,,,,,BOTH,,,19.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN - FREE,99734-6,CDM,300,RC,80186,CPT,,,,,BOTH,,,76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILANTIN (PHENYTOIN),91115-6,CDM,300,RC,80185,CPT,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILANTIN-(PHENYTOIN) REPEAT,99964-9,CDM,300,RC,80185,CPT,,,91,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRIMIDONE-PHENOBARB,101429-9,CDM,300,RC,80184,CPT,,,,,BOTH,,,19.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENOBARBITOL,91137-0,CDM,300,RC,80184,CPT,,,,,BOTH,,,148,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXCARBAZEPINE,99596-9,CDM,300,RC,80183,CPT,,,,,BOTH,,,151,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LITHIUM,91133-9,CDM,300,RC,80178,CPT,,,,,BOTH,,,37,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVETIRACETAM,99703-1,CDM,300,RC,80177,CPT,,,,,BOTH,,,162,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE,99336-0,CDM,300,RC,80176,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALDOL,99763-5,CDM,300,RC,80173,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN,99419-4,CDM,300,RC,80171,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN - REPEAT,82765-9,CDM,300,RC,80170,CPT,,,91,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMYCIN TROUGH,91126-3,CDM,300,RC,80170,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FELBAMATE,99376-6,CDM,300,RC,80167,CPT,,,,,BOTH,,,130,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPAKENE,91147-9,CDM,300,RC,80164,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGOXIN (LANOXIN),91100-8,CDM,300,RC,80162,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGOXIN REPEAT,101185-7,CDM,300,RC,80162,CPT,,,91,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOZAPINE,99782-5,CDM,300,RC,80159,CPT,,,,,BOTH,,,238,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCLOSPORINE A,99532-4,CDM,300,RC,80158,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEGRETOL,91101-6,CDM,300,RC,80156,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CAFFEINE,99315-4,CDM,300,RC,80155,CPT,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UR DRUGSR PVT,101299-6,CDM,300,RC,80104,CPT,,,,,BOTH,,,130,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VALIUM-URINE CONF,99698-3,CDM,300,RC,80102,CPT,,,,,BOTH,,,41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG CONFIRMATION URINE REPEAT,99593-6,CDM,300,RC,80102,CPT,,,91,,BOTH,,,90,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN SCREEN URINE-REPEAT,99925-0,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPHET SCREEN URINE-REPEAT,99926-8,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARBITURATES SCREEN URINE - REPEAT,99927-6,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZO SCREEN URINE - REPEAT,99928-4,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCAINE SCREEN URINE REPEAT,99929-2,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHADONE SCREEN URINE REPEAT,99930-0,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OPIATES SCREEN URINE REPEAT,99931-8,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCP SCREEN URINE REPEAT,99932-6,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TCA SCREEN URINE REPEAT,99934-2,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THC SCREEN URINE REPEAT,99933-4,CDM,300,RC,80101,CPT,,,91,,BOTH,,,13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-AMP,101139-4,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-BAR,101140-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-BEN,101141-0,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-CAN,101142-8,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-COC,101143-6,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-PCP,101145-1,CDM,300,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-AMPH,101084-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-BARB,101083-4,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-BENZO,101082-6,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-COC,101080-0,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-FENT,101072-7,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-MEP,101074-3,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-MTD,101076-8,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-OPIATE,101079-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-OXYC,101078-4,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-PHENCY,101077-6,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-PROP,101075-0,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-THC,101081-8,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PANEL 764548-TRAM,101073-5,CDM,300,RC,80101,CPT,,,,,BOTH,,,27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DCBS DRUG SCREEN,99887-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARBITURATE-BLD(PANE,99902-9,CDM,300,RC,80101,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZO-BLOOD (PANEL),99903-7,CDM,300,RC,80101,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCAINE-BLOOD (PANEL),99905-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCP-BLOOD (PANEL),99907-8,CDM,300,RC,80101,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THC-BLOOD (PANEL),99904-5,CDM,300,RC,80101,CPT,,,,,BOTH,,,63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE-URINE SCREEN,101003-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,139,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPHONE URINE CONIFRMATION,99609-0,CDM,300,RC,80101,CPT,,,,,BOTH,,,300,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE URINE CONFIRMATION,99608-2,CDM,300,RC,80101,CPT,,,,,BOTH,,,474,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATIC FUNCTION PANEL,99289-1,CDM,300,RC,80076,CPT,,,,,BOTH,,,30,,,73,,5,4,5,1 through 10,percent of total billed charges,,,73,,5,4,5,1 through 10,percent of total billed charges,,,73,,5,4,5,1 through 10,percent of total billed charges,,,73,,5,4,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
HEPATITIS PROFILE ACUTE,91078-6,CDM,300,RC,80074,CPT,,,,,BOTH,,,220,,,73,,40,26.3,40,1 through 10,percent of total billed charges,,,73,,40,26.3,40,1 through 10,percent of total billed charges,,,73,,40,26.3,40,1 through 10,percent of total billed charges,,,73,,40,26.3,40,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,38,38,38,1 through 10,percent of total billed charges,,,,
RENAL FUNC PANEL RPT,101525-4,CDM,300,RC,80069,CPT,,,91,,BOTH,,,114,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RENAL FUNCTION PANEL,99428-5,CDM,300,RC,80069,CPT,,,,,BOTH,,,114,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIPID PROFILE,91079-4,CDM,300,RC,80061,CPT,,,,,BOTH,,,86,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,8.4,10,15,percent of total billed charges,,,,
CMP REPEAT,99829-4,CDM,300,RC,80053,CPT,,,91,,BOTH,,,52,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,6,8,43,percent of total billed charges,,,,
COMPREHENSIVE METABOLIC PANEL,99288-3,CDM,300,RC,80053,CPT,,,,,BOTH,,,52,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,73,,7,5,7,229,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,8,6,8,43,percent of total billed charges,,,,
ELECTROLYTES PANEL,99286-7,CDM,300,RC,80051,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENERAL HEALTH PANEL,99429-3,CDM,300,RC,80050,CPT,,,,,BOTH,,,199,,,73,,10,8,10,190,percent of total billed charges,,,73,,10,8,10,190,percent of total billed charges,,,73,,10,8,10,190,percent of total billed charges,,,73,,10,8,10,190,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BASIC METABOLIC PANEL,99287-5,CDM,300,RC,80048,CPT,,,,,BOTH,,,35,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5.2,6,1 through 10,percent of total billed charges,,,,
CAPILLARY BLOOD COLL,101126-1,CDM,300,RC,36416,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENIPUNCTURE,109-9,CDM,300,RC,36415,CPT,,,,,BOTH,,,20,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,51,percent of total billed charges,,,,
VENIPUNCTURE,127-1,CDM,300,RC,36415,CPT,,,,,BOTH,,,20,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,51,percent of total billed charges,,,,
VENIPUNCTURE,91190-9,CDM,300,RC,36415,CPT,,,,,BOTH,,,20,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,73,,5,4,41,795,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,51,percent of total billed charges,,,,
EMPLOYEE LABS,99150-5,CDM,300,RC,,,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLLECTION FEE,99196-8,CDM,300,RC,,,,,,,BOTH,,,25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFLUENZA B,198-2,CDM,300,RC,,,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEPTOSPIRAL ANTIBODIES,99752-8,CDM,300,RC,,,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EKG(OVERREAD),90021-7,CDM,300,RC,,,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WASHED RBC PROCESS,99012-7,CDM,300,RC,,,,,,,BOTH,,,145.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET APHERESIS,99819-5,CDM,301,RC,P9035,HCPCS,,,,,BOTH,,,882.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSA SCREENING,99717-1,CDM,301,RC,G0103,HCPCS,,,,,BOTH,,,110,,,73,,15,13.2,15,1 through 10,percent of total billed charges,,,73,,15,13.2,15,1 through 10,percent of total billed charges,,,73,,15,13.2,15,1 through 10,percent of total billed charges,,,73,,15,13.2,15,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHOL FLUID,101481-0,CDM,301,RC,89060,CPT,,,,,BOTH,,,48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VZV PCR,101455-4,CDM,301,RC,87798,CPT,,,,,BOTH,,,250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUNGITELL BETA D GI,101730-0,CDM,301,RC,87449,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV ANTIBODY SCREEN,101283-0,CDM,301,RC,86803,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VGCC ANTIBODY,99707-2,CDM,301,RC,86596,CPT,,,,,BOTH,,,378,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-TRANSGLUTAMINASE A,101055-2,CDM,301,RC,86364,CPT,,,,,BOTH,,,51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-TRANSGLUTAMINASE G,101054-5,CDM,301,RC,86364,CPT,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAD 65 AUTOANTIBODY,99765-0,CDM,301,RC,86341,CPT,,,,,BOTH,,,194,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE-CSF,101240-0,CDM,301,RC,86335,CPT,,,,,BOTH,,,71.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-IFE E,91238-6,CDM,301,RC,86334,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROM GRANIN,101507-2,CDM,301,RC,86316,CPT,,,,,BOTH,,,115,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIGLIADIN AB IGA,99739-5,CDM,301,RC,86258,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANCA PANEL-FL.NON.AB,101086-7,CDM,301,RC,86256,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RETICULIN IGA AB,99737-9,CDM,301,RC,86255,CPT,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RETICULIN IGG AB,99735-3,CDM,301,RC,86255,CPT,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTICHROMATIN IGG,99787-4,CDM,301,RC,86235,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HISTONE AB,99556-3,CDM,301,RC,86235,CPT,,,,,BOTH,,,134,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTICARDIOLIPIN AI R,99741-1,CDM,301,RC,86147,CPT,,,91,,BOTH,,,139,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,73,,21,21,21,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM CRP,101273-1,CDM,301,RC,86140,CPT,,,,,BOTH,,,66.85,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
LATEX ALLERGY BY IMMUNOCAP,99888-0,CDM,301,RC,86003,CPT,,,,,BOTH,,,198,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ANTI-THROMB III AG,99747-8,CDM,301,RC,85301,CPT,,,,,BOTH,,,32,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR IX AG,101439-8,CDM,301,RC,85250,CPT,,,,,BOTH,,,300,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM STOOL,101442-2,CDM,301,RC,84999,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFP-HCG QUANT,101219-4,CDM,301,RC,84702,CPT,,,,,BOTH,,,27.38,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,73,,12,12,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC UR RPT,101214-5,CDM,301,RC,84630,CPT,,,91,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZINC-URINE,99750-2,CDM,301,RC,84630,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B3,101239-2,CDM,301,RC,84591,CPT,,,,,BOTH,,,414,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN A,99827-8,CDM,301,RC,84590,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIDIURETIC HORMONE,99712-2,CDM,301,RC,84588,CPT,,,,,BOTH,,,82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIP PLASMA,101475-2,CDM,301,RC,84586,CPT,,,,,BOTH,,,54.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUN POST DIALYSIS,101664-1,CDM,301,RC,84520,CPT,,,91,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUN REPEAT,101414-1,CDM,301,RC,84520,CPT,,,91,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAGE TNI,101668-2,CDM,301,RC,84484,CPT,,,,,BOTH,,,43,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,43,43,43,1 through 10,percent of total billed charges,,,,
TROPONIN,99434-3,CDM,301,RC,84484,CPT,,,,,BOTH,,,43,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,43,43,43,1 through 10,percent of total billed charges,,,,
TROPONIN REPEAT,99544-9,CDM,301,RC,84484,CPT,,,91,,BOTH,,,43,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,73,,8,5.6,43,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,43,43,43,1 through 10,percent of total billed charges,,,,
REVERSE T3,99812-0,CDM,301,RC,84482,CPT,,,,,BOTH,,,154,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T3(RIA),91324-4,CDM,301,RC,84480,CPT,,,,,BOTH,,,92,,,73,,9,4,12,1 through 10,percent of total billed charges,,,73,,9,4,12,1 through 10,percent of total billed charges,,,73,,9,4,12,1 through 10,percent of total billed charges,,,73,,9,4,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIG FLUID,101479-4,CDM,301,RC,84478,CPT,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV-SGPT,99876-5,CDM,301,RC,84460,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE - ALT,99944-1,CDM,301,RC,84460,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CBG CORT ST GLOB,101501-5,CDM,301,RC,84449,CPT,,,,,BOTH,,,46.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN E,99826-0,CDM,301,RC,84446,CPT,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TSH REPEAT,101212-9,CDM,301,RC,84443,CPT,,,91,,BOTH,,,77,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,73,,14,11,82.4,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,12,11,13,15,percent of total billed charges,,,,
TESTOSTERONE-FREE,99713-0,CDM,301,RC,84402,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFATE 24 HR URINE,99725-4,CDM,301,RC,84392,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FECAL REDUCING SUBSTANCES,101119-6,CDM,301,RC,84377,CPT,,,,,BOTH,,,26.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STOOL REDUCING SUBST,101530-4,CDM,301,RC,84376,CPT,,,,,BOTH,,,46.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIFIC GRAV-FLD,101316-8,CDM,301,RC,84315,CPT,,,,,BOTH,,,84.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADA FLUID,101480-2,CDM,301,RC,84311,CPT,,,,,BOTH,,,139.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGF-1,101228-5,CDM,301,RC,84305,CPT,,,,,BOTH,,,96.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM STOOL,101443-0,CDM,301,RC,84302,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM 24 HR URINE,99724-7,CDM,301,RC,84300,CPT,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NA (SODIUM) REPEAT,99867-4,CDM,301,RC,84295,CPT,,,91,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEROTONIN,101042-0,CDM,301,RC,84260,CPT,,,,,BOTH,,,120,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SELENIUM,99818-7,CDM,301,RC,84255,CPT,,,,,BOTH,,,344,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN B2,101151-9,CDM,301,RC,84252,CPT,,,,,BOTH,,,70.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"RENIN, PLASMA",99862-5,CDM,301,RC,84244,CPT,,,,,BOTH,,,76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISLET CELL DYSF-PRO INSULIN,99924-3,CDM,301,RC,84206,CPT,,,,,BOTH,,,130,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PE-ELECTR CSF,101242-6,CDM,301,RC,84166,CPT,,,,,BOTH,,,23.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN ELEC 24HR UR,101691-4,CDM,301,RC,84166,CPT,,,,,BOTH,,,155,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-PRO E,91236-0,CDM,301,RC,84165,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PE-PROTEIN CSF,101241-8,CDM,301,RC,84157,CPT,,,,,BOTH,,,23.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-T PRO,91234-5,CDM,301,RC,84155,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSA ULTRA-SENS,101510-6,CDM,301,RC,84153,CPT,,,,,BOTH,,,71.25,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,73,,12,4.8,14.1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,15,15,15,1 through 10,percent of total billed charges,,,,
PROCALCITONIN,101717-7,CDM,301,RC,84145,CPT,,,,,BOTH,,,68,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCALCITONIN,101297-0,CDM,301,RC,84145,CPT,,,,,BOTH,,,502,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,73,,22,18.8,58.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
17-HYDROXYPREGNENOLO,99799-9,CDM,301,RC,84143,CPT,,,,,BOTH,,,246,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGNENOLONE MS,101148-5,CDM,301,RC,84140,CPT,,,,,BOTH,,,136,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREALBUMIN,99578-7,CDM,301,RC,84134,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHORUS 24 HR URINE,99727-0,CDM,301,RC,84105,CPT,,,,,BOTH,,,16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHOSPHORUS REF LAB,101296-2,CDM,301,RC,84100,CPT,,,,,BOTH,,,28,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,73,,3,3,11.2,31,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALK PHOS,90049-8,CDM,301,RC,84075,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
POTASSIUM 24HR URINE,101701-1,CDM,301,RC,84033,CPT,,,,,BOTH,,,25.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CALPROTECTIN, FECAL",101704-5,CDM,301,RC,83993,CPT,,,,,BOTH,,,125,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENCYCLIDINE CONF U,101004-0,CDM,301,RC,83992,CPT,,,,,BOTH,,,94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PCP BLOOD,101323-4,CDM,301,RC,83992,CPT,,,,,BOTH,,,310,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PH BODY FLUID,101259-0,CDM,301,RC,83986,CPT,,,,,BOTH,,,8.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSTEOCALCIN,101407-5,CDM,301,RC,83937,CPT,,,,,BOTH,,,59.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPOXYPHENE,99730-4,CDM,301,RC,83925,CPT,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
5 NUCLEOTIDASE,101294-7,CDM,301,RC,83915,CPT,,,,,BOTH,,,46.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTORII DNA ANAL-IN,101136-0,CDM,301,RC,83912,CPT,,,,,BOTH,,,61.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTORII DNA ANAL-AM,101135-2,CDM,301,RC,83898,CPT,,,,,BOTH,,,61.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTORII DNA ANAL-GE,101134-5,CDM,301,RC,83894,CPT,,,,,BOTH,,,61.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTORII DNA ANAL-EN,101133-7,CDM,301,RC,83892,CPT,,,,,BOTH,,,61.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR V LEIDEN-ISOLATION OR EXTRACTION,101106-3,CDM,301,RC,83891,CPT,,,,,BOTH,,,51.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTORII DNA ANAL-EX,101132-9,CDM,301,RC,83891,CPT,,,,,BOTH,,,61.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV-NEPHELOMETRY,99871-6,CDM,301,RC,83883,CPT,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEPHELOMETRY,99870-8,CDM,301,RC,83883,CPT,,,,,BOTH,,,54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE-NEPH ANALYTE EA,99945-8,CDM,301,RC,83883,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAGE MYO,101667-4,CDM,301,RC,83874,CPT,,,,,BOTH,,,56,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEAVY METAL-MERCURY,101304-4,CDM,301,RC,83825,CPT,,,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACLOFEN,101037-0,CDM,301,RC,83789,CPT,,,,,BOTH,,,433.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MANGANESE,99841-9,CDM,301,RC,83785,CPT,,,,,BOTH,,,198,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NMR-PARTICLE #,101209-5,CDM,301,RC,83704,CPT,,,,,BOTH,,,37.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUANT OF LIPOPROTEIN PARTICLE #'S,99820-3,CDM,301,RC,83704,CPT,,,,,BOTH,,,395,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIPASE,91132-1,CDM,301,RC,83690,CPT,,,,,BOTH,,,30,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,25,1 through 10,percent of total billed charges,,,,
LIPASE,101713-6,CDM,301,RC,83690,CPT,,,,,BOTH,,,30,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,25,1 through 10,percent of total billed charges,,,,
LIPASE REPEAT,101521-3,CDM,301,RC,83690,CPT,,,91,,BOTH,,,30,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,25,1 through 10,percent of total billed charges,,,,
HEAVY METAL-LEAD,101302-8,CDM,301,RC,83655,CPT,,,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LDH BODY FLUID,101554-4,CDM,301,RC,83615,CPT,,,,,BOTH,,,15.13,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPOC LACTIC ACID,101666-6,CDM,301,RC,83605,CPT,,,,,BOTH,,,30,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTIC ACID REPEAT,101542-9,CDM,301,RC,83605,CPT,,,91,,BOTH,,,30,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTIC ACID BODY FLD,101700-3,CDM,301,RC,83605,CPT,,,,,BOTH,,,61,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,73,,9,8.4,30,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ISLET CELL DYSF-INSULIN,99923-5,CDM,301,RC,83525,CPT,,,,,BOTH,,,130,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FREE K LT CHAIN QN S,99857-5,CDM,301,RC,83521,CPT,,,,,BOTH,,,170,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FREE K+L LT CHAINS Q,99856-7,CDM,301,RC,83521,CPT,,,,,BOTH,,,170,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FREE L LT CHAIN QN S,99861-7,CDM,301,RC,83521,CPT,,,,,BOTH,,,170,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,73,,5,5,5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGF-BP3,101535-3,CDM,301,RC,83520,CPT,,,,,BOTH,,,43.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IA,101269-9,CDM,301,RC,83520,CPT,,,,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IA,101270-7,CDM,301,RC,83520,CPT,,,91,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANCA PANEL-IMMUNOASQ,101087-5,CDM,301,RC,83520,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIPROTEINASE 3 ABS,101103-0,CDM,301,RC,83520,CPT,,,,,BOTH,,,75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR VIII AG,101440-6,CDM,301,RC,83520,CPT,,,,,BOTH,,,166.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROTROPIN RECEPTAB,99761-9,CDM,301,RC,83520,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRYPTASE,99869-0,CDM,301,RC,83520,CPT,,,,,BOTH,,,264,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOASSAY QUANT NOT SPECIFIED,99832-8,CDM,301,RC,83520,CPT,,,,,BOTH,,,666,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGF-2,99914-4,CDM,301,RC,83519,CPT,,,,,BOTH,,,168,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TSH RECEPTOR AB,99503-5,CDM,301,RC,83519,CPT,,,,,BOTH,,,287,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOASSAY OTHER IN,99777-5,CDM,301,RC,83516,CPT,,,,,BOTH,,,28.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIADIN IGA AB,101057-8,CDM,301,RC,83516,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIADIN IGG AB,101056-0,CDM,301,RC,83516,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI-GLIADIN AB IGG,99736-1,CDM,301,RC,83516,CPT,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CCP IGG ANTIBODIES,99718-9,CDM,301,RC,83516,CPT,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIDEOXYRIBONUCLEOPROTEION,99899-7,CDM,301,RC,83516,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI-PARIETAL AB,101319-2,CDM,301,RC,83516,CPT,,,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIADIN IGG/IGA,99978-9,CDM,301,RC,83516,CPT,,,,,BOTH,,,68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIMYELOPEROXIDASEA,101102-2,CDM,301,RC,83516,CPT,,,,,BOTH,,,75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPHA GALACTOSE IGE,101426-5,CDM,301,RC,83516,CPT,,,,,BOTH,,,125,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T-TRANSG (TTG)IGA,99706-4,CDM,301,RC,83516,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOWEL DISORDER,101474-5,CDM,301,RC,83516,CPT,,,,,BOTH,,,220,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BOWEL DISORDER CASCA,101519-7,CDM,301,RC,83516,CPT,,,,,BOTH,,,220,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP180,99844-3,CDM,301,RC,83516,CPT,,,,,BOTH,,,337,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BP230,99843-5,CDM,301,RC,83516,CPT,,,,,BOTH,,,337,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOASSAY OTHER INF. AGENT AB OR AG REPEAT,99778-3,CDM,301,RC,83516,CPT,,,91,,BOTH,,,368,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
17-OH PROGESTERONE,101432-3,CDM,301,RC,83498,CPT,,,,,BOTH,,,58.04,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
17-A-HYDROXYPROG UR,99800-5,CDM,301,RC,83498,CPT,,,,,BOTH,,,98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFHEMOGLOBIN,101246-7,CDM,301,RC,83060,CPT,,,,,BOTH,,,193,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHEMOGLOBIN,101245-9,CDM,301,RC,83050,CPT,,,,,BOTH,,,20.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIMONY UR,101421-6,CDM,301,RC,83018,CPT,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COBALT,101293-9,CDM,301,RC,83018,CPT,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BERYLLIUM UR,101418-2,CDM,301,RC,83018,CPT,,,,,BOTH,,,172.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARIUM UR,101419-0,CDM,301,RC,83018,CPT,,,,,BOTH,,,204.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE-HAPTOGLOBIN,99946-6,CDM,301,RC,83010,CPT,,,,,BOTH,,,64,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,10,10,1 through 10,percent of total billed charges,,,,
HCV-HAPTOGLOBIN,99875-7,CDM,301,RC,83010,CPT,,,,,BOTH,,,160,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,10,10,1 through 10,percent of total billed charges,,,,
GLYCATED ALBUMIN,101149-3,CDM,301,RC,82985,CPT,,,,,BOTH,,,323.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV-GGT,99874-0,CDM,301,RC,82977,CPT,,,,,BOTH,,,38,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE -GGT,99947-4,CDM,301,RC,82977,CPT,,,,,BOTH,,,64,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,73,,4,4,6,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
G6PD QUANT,99686-8,CDM,301,RC,82955,CPT,,,,,BOTH,,,30,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
2 HR GTT 100G,101645-0,CDM,301,RC,82951,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
2 HR GTT 50G,101652-6,CDM,301,RC,82951,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
2 HR GTT 75G,101644-3,CDM,301,RC,82951,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG 1 SUBCLASS,101025-5,CDM,301,RC,82787,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG 2 SUBCLASS,101026-3,CDM,301,RC,82787,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG 3 SUBCLASS,101027-1,CDM,301,RC,82787,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG 4 SUBCLASS,101028-9,CDM,301,RC,82787,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PED IGE,101497-6,CDM,301,RC,82785,CPT,,,,,BOTH,,,10,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,13,13,13,1 through 10,percent of total billed charges,,,,
GAMMAGLOB PANEL -IGE,101090-9,CDM,301,RC,82785,CPT,,,,,BOTH,,,15.5,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,73,,13,11.8,170,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,13,13,13,1 through 10,percent of total billed charges,,,,
GAMMAGLOB PANEL-IGA,101091-7,CDM,301,RC,82784,CPT,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAMMAGLOB PANEL-IGG,101089-1,CDM,301,RC,82784,CPT,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GAMMAGLOB PANEL-IGM,101088-3,CDM,301,RC,82784,CPT,,,,,BOTH,,,15.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-IGG,91227-9,CDM,301,RC,82784,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-IGM,91230-3,CDM,301,RC,82784,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IFE & PE SERUM-IGH,91228-7,CDM,301,RC,82784,CPT,,,,,BOTH,,,19.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IGG TOTAL (SUBCLASSES),101024-8,CDM,301,RC,82784,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRONE,101203-8,CDM,301,RC,82679,CPT,,,,,BOTH,,,67.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFP-ESTRIOL,101218-6,CDM,301,RC,82677,CPT,,,,,BOTH,,,27.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTROGEN - TOTAL,99733-8,CDM,301,RC,82672,CPT,,,,,BOTH,,,66,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTROGEN FRACTIONATED,91121-4,CDM,301,RC,82671,CPT,,,,,BOTH,,,184,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PANCREATIC ELAST FEC,101729-2,CDM,301,RC,82653,CPT,,,,,BOTH,,,262.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCITRIOL,101408-3,CDM,301,RC,82652,CPT,,,,,BOTH,,,120.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIHYDROTESTOSTERONE,101258-2,CDM,301,RC,82642,CPT,,,,,BOTH,,,152,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
11 - DEOXYCORTISOL,99681-9,CDM,301,RC,82634,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DHEA S,99688-4,CDM,301,RC,82627,CPT,,,,,BOTH,,,25,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,73,,18,18,18,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DHEA,99858-3,CDM,301,RC,82626,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYSTATIN C,101728-4,CDM,301,RC,82610,CPT,,,,,BOTH,,,142.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREATININE 24HR URIN,101702-9,CDM,301,RC,82570,CPT,,,,,BOTH,,,12.95,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CREATININE UR RPT,101216-0,CDM,301,RC,82570,CPT,,,91,,BOTH,,,23,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HEAVY METAL-CREAT,101301-0,CDM,301,RC,82570,CPT,,,,,BOTH,,,45,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,73,,4,4,4,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
GLOM FILTRATION RATE,99913-6,CDM,301,RC,82565,CPT,,,,,BOTH,,,14,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,73,,4,3,7.1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIAGE MB,101669-0,CDM,301,RC,82553,CPT,,,,,BOTH,,,29,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,73,,5,4,26.6,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
RITALIN,101324-2,CDM,301,RC,82542,CPT,,,,,BOTH,,,180,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CREATINE URINE,101410-9,CDM,301,RC,82540,CPT,,,,,BOTH,,,18.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CREATINE, SERUM",99982-1,CDM,301,RC,82540,CPT,,,,,BOTH,,,19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COPPER UR RPT,101215-2,CDM,301,RC,82525,CPT,,,91,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COPPER-URINE,99749-4,CDM,301,RC,82525,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
N-TELOPEPTIDE URINE,99774-2,CDM,301,RC,82523,CPT,,,91,,BOTH,,,241,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
N-TELOPEPTIDE,101406-7,CDM,301,RC,82523,CPT,,,,,BOTH,,,337,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMIUM,99817-9,CDM,301,RC,82495,CPT,,,,,BOTH,,,288,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARISOPRODOL (SOMA),99935-9,CDM,301,RC,82491,CPT,,,,,BOTH,,,68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAMOTRIGINE (LAMICTAL),101008-1,CDM,301,RC,82491,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAXIL URINE,99884-9,CDM,301,RC,82491,CPT,,,,,BOTH,,,254,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLOFT URINE,99883-1,CDM,301,RC,82491,CPT,,,,,BOTH,,,254,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROZAC URINE,99882-3,CDM,301,RC,82491,CPT,,,,,BOTH,,,264,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORIDE STOOL,101441-4,CDM,301,RC,82438,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM CHEM ASSAY,101271-5,CDM,301,RC,82397,CPT,,,,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM CHEM ASSAY,101272-3,CDM,301,RC,82397,CPT,,,91,,BOTH,,,66.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTI MULLERIAN HORM,101499-2,CDM,301,RC,82397,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARNITINE,101315-0,CDM,301,RC,82379,CPT,,,,,BOTH,,,62.84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCULI ANALYSIS,91042-2,CDM,301,RC,82365,CPT,,,,,BOTH,,,158,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CALCIUM RANDOM UR,101508-0,CDM,301,RC,82340,CPT,,,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN D FRACT,101412-5,CDM,301,RC,82306,CPT,,,,,BOTH,,,340,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,73,,23,17,23,111,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,24,18.5,24,1 through 10,percent of total billed charges,,,,
FECAL OCC BLD IMM DX,99837-7,CDM,301,RC,82274,CPT,,,QW,,BOTH,,,45,,,73,,45,45,45,1 through 10,percent of total billed charges,,,73,,45,45,45,1 through 10,percent of total billed charges,,,73,,45,45,45,1 through 10,percent of total billed charges,,,73,,45,45,45,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,13,13,13,1 through 10,percent of total billed charges,,,,
OCCULT BLD GUAIAC ER,101314-3,CDM,301,RC,82272,CPT,,,,,BOTH,,,6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OCCULT BLOOD-GASTRIC,99838-5,CDM,301,RC,82271,CPT,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OCCULT BLOOD SCREEN,99771-8,CDM,301,RC,82270,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV-TOTAL BILIRUBIN,99873-2,CDM,301,RC,82247,CPT,,,,,BOTH,,,23,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE - T BILI,99948-2,CDM,301,RC,82247,CPT,,,,,BOTH,,,64,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,73,,3,3,4,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUTALBITAL,101229-3,CDM,301,RC,82205,CPT,,,,,BOTH,,,48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN C,99768-4,CDM,301,RC,82180,CPT,,,,,BOTH,,,52,,,73,,4,4,4,1 through 10,percent of total billed charges,,,73,,4,4,4,1 through 10,percent of total billed charges,,,73,,4,4,4,1 through 10,percent of total billed charges,,,73,,4,4,4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEAVY METAL-ARSENIC,101303-6,CDM,301,RC,82175,CPT,,,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV FIBROSURE-APOLIPOPROTEIN,99949-0,CDM,301,RC,82172,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV-LIPROPROTEIN A,99872-4,CDM,301,RC,82172,CPT,,,,,BOTH,,,142,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANDROSTENEDIONE,99801-3,CDM,301,RC,82157,CPT,,,,,BOTH,,,127,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPH CONFIRM-BLOOD,101150-1,CDM,301,RC,82145,CPT,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMMONIA IN-HOUSE,101298-8,CDM,301,RC,82140,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMMONIA REPEAT,101498-4,CDM,301,RC,82140,CPT,,,91,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALA - DELTA URINE,99732-0,CDM,301,RC,82135,CPT,,,,,BOTH,,,52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYSTINE 24 HR URINE,99726-2,CDM,301,RC,82131,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFP-MATERNAL,101217-8,CDM,301,RC,82105,CPT,,,,,BOTH,,,27.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALPHA 1 ANTITRYP PHE,101336-6,CDM,301,RC,82104,CPT,,,,,BOTH,,,26.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUMIN BODY FLD,101306-9,CDM,301,RC,82042,CPT,,,,,BOTH,,,9.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETEST,99859-1,CDM,301,RC,82009,CPT,,,,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETEST-REPEAT,101526-2,CDM,301,RC,82009,CPT,,,91,,BOTH,,,3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPOXYPHENE CONF UR,101005-7,CDM,301,RC,80367,CPT,,,,,BOTH,,,94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OXYCODONE,99983-9,CDM,301,RC,80365,CPT,,,,,BOTH,,,283,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OPIATES URINE GS/MS,101038-8,CDM,301,RC,80361,CPT,,,,,BOTH,,,184,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE SERUM,99798-1,CDM,301,RC,80361,CPT,,,,,BOTH,,,299,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROCODONE CONF UR,101040-4,CDM,301,RC,80361,CPT,,,,,BOTH,,,365,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THC CONF BLOOD,99900-3,CDM,301,RC,80349,CPT,,,,,BOTH,,,384,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZODIAZEPINE BLOOD,99889-8,CDM,301,RC,80347,CPT,,,,,BOTH,,,432,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUPRENORPHINE SERUM,99973-0,CDM,301,RC,80345,CPT,,,,,BOTH,,,343,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TCA-URINE CONF,99866-6,CDM,301,RC,80337,CPT,,,,,BOTH,,,250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPHETAMINE CONF,99521-7,CDM,301,RC,80324,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPHEDRINE,101454-7,CDM,301,RC,80324,CPT,,,,,BOTH,,,164,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VOLATILES BLOOD,101070-1,CDM,301,RC,80320,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VOLATILES URINE,99411-1,CDM,301,RC,80320,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NICOTINE URINE,99863-3,CDM,301,RC,80307,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COC UDS,101712-8,CDM,301,RC,80307,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPERIDINE,101255-8,CDM,301,RC,80307,CPT,,,,,BOTH,,,60,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GABAPENTIN URINE LX,101692-2,CDM,301,RC,80307,CPT,,,,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PENTAZOCINE,101260-8,CDM,301,RC,80307,CPT,,,,,BOTH,,,233.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UR DRUG SCR MEDTX,101191-5,CDM,301,RC,80306,CPT,,,,,BOTH,,,130,,,73,,8,6.2,128.4,12,percent of total billed charges,,,73,,8,6.2,128.4,12,percent of total billed charges,,,73,,8,6.2,128.4,12,percent of total billed charges,,,73,,8,6.2,128.4,12,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,11,11,11,1 through 10,percent of total billed charges,,,,
FENTANYL URINE,99586-0,CDM,301,RC,80299,CPT,,,,,BOTH,,,31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHADONE SERUM,99680-1,CDM,301,RC,80299,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WARFARIN LEVEL,101285-5,CDM,301,RC,80299,CPT,,,,,BOTH,,,51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEROQUEL/QUETIAPINE,101513-0,CDM,301,RC,80299,CPT,,,,,BOTH,,,115,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAMADOL,99877-3,CDM,301,RC,80299,CPT,,,,,BOTH,,,127,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM LEVEL,101247-5,CDM,301,RC,80299,CPT,,,,,BOTH,,,167,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE LEVEL,101249-1,CDM,301,RC,80299,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERIDONE,99915-1,CDM,301,RC,80299,CPT,,,,,BOTH,,,262,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREGABALIN (LYRICA),99910-2,CDM,301,RC,80299,CPT,,,,,BOTH,,,290,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLPIDEM LEVEL,101248-3,CDM,301,RC,80299,CPT,,,,,BOTH,,,333,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZONISAMIDE (ZONEGRAN),99839-3,CDM,301,RC,80203,CPT,,,,,BOTH,,,256,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN PEAK,101660-9,CDM,301,RC,80200,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN TROUGH,101661-7,CDM,301,RC,80200,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEFLUNOMIDE,101413-3,CDM,301,RC,80198,CPT,,,,,BOTH,,,350.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RAPAMUNE,99756-9,CDM,301,RC,80195,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAMOTRIGINE,101059-4,CDM,301,RC,80175,CPT,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN PEAK,101641-9,CDM,301,RC,80170,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN RANDOM,101640-1,CDM,301,RC,80170,CPT,,,,,BOTH,,,92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EVEROLIMUS,101703-7,CDM,301,RC,80169,CPT,,,,,BOTH,,,64.25,,,73,,14,14,18,13,percent of total billed charges,,,73,,14,14,18,13,percent of total billed charges,,,73,,14,14,18,13,percent of total billed charges,,,73,,14,14,18,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETHOSUXIMIDE (ZARONTIN),99714-8,CDM,301,RC,80168,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"CARBAMAZEPINE-10,11 EPOXIDE REPEAT",99790-8,CDM,301,RC,80156,CPT,,,91,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIODARONE,99748-6,CDM,301,RC,80151,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIKACIN,101445-5,CDM,301,RC,80150,CPT,,,,,BOTH,,,41.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIKACIN PEAK,101714-4,CDM,301,RC,80150,CPT,,,,,BOTH,,,41.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIKACIN TROUGH,101715-1,CDM,301,RC,80150,CPT,,,,,BOTH,,,41.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRUG PROF 766477-OPI,101144-4,CDM,301,RC,80101,CPT,,,,,BOTH,,,26.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NMR-LIPID PROF,101208-7,CDM,301,RC,80061,CPT,,,,,BOTH,,,37.74,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,8.4,10,15,percent of total billed charges,,,,
LIPID PANEL REPEAT,101147-7,CDM,301,RC,80061,CPT,,,91,,BOTH,,,86,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,73,,9,7,9,204,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,10,8.4,10,15,percent of total billed charges,,,,
ELECTROLYTE REPEAT,99281-8,CDM,301,RC,80051,CPT,,,91,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BMP REPEAT,99590-2,CDM,301,RC,80048,CPT,,,91,,BOTH,,,35,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,73,,5,4.8,5,52,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5.2,6,1 through 10,percent of total billed charges,,,,
EPOC BMP,101665-8,CDM,301,RC,80045,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BISMUTH UR,101420-8,CDM,301,RC,,,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV-SCREENING-EIA TECHNIQUE,101125-3,CDM,302,RC,G0432,HCPCS,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRYPTOCOCCAL AG,99090-3,CDM,302,RC,87899,CPT,,,,,BOTH,,,34.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GC & CHLAMYDIA DNA PROBE,99311-3,CDM,302,RC,87800,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RSV (LC) ALL AGES,101699-7,CDM,302,RC,87420,CPT,,,,,BOTH,,,44.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC ABSORPTION OF SERUM,99794-0,CDM,302,RC,86978,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC DILUTION OF SERUM,99795-7,CDM,302,RC,86976,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS PRETREATMENT WITH ENZYMES,99792-4,CDM,302,RC,86971,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC PRETREATMENT OF RBC'S,99793-2,CDM,302,RC,86970,CPT,,,,,BOTH,,,102,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC PT SERA AG SCR/UN,101415-8,CDM,302,RC,86904,CPT,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RC INDIRECT TITER,99796-5,CDM,302,RC,86886,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIBODY IDENTIFICAT,99770-0,CDM,302,RC,86870,CPT,,,,,BOTH,,,72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RED CROSS ELUTION,99797-3,CDM,302,RC,86860,CPT,,,,,BOTH,,,152,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HLA CLASS II AB,101505-6,CDM,302,RC,86833,CPT,,,,,BOTH,,,285,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HLA CLASS I AB,101504-9,CDM,302,RC,86832,CPT,,,,,BOTH,,,285,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEP C VERIFY,101409-1,CDM,302,RC,86804,CPT,,,,,BOTH,,,360,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS E IGG,101706-0,CDM,302,RC,86790,CPT,,,,,BOTH,,,85.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS E IGM,101707-8,CDM,302,RC,86790,CPT,,,,,BOTH,,,85.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEST NILE VIRUS IGG,99662-9,CDM,302,RC,86789,CPT,,,,,BOTH,,,182,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEST NILE VIRUS IGM,99661-1,CDM,302,RC,86788,CPT,,,,,BOTH,,,182,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VARICELLA ZOSTER IGG,101007-3,CDM,302,RC,86787,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TOXOPLASMA, GONDII IGM",99694-2,CDM,302,RC,86778,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SARS-COV-2 AB NUCLEO,101709-4,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SARS-COV-2 SPIKE AB,101710-2,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AB IGA,91249-3,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AB IGG,91251-9,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AB IGM,91250-1,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID AB SEMI-QUANT,91248-5,CDM,302,RC,86769,CPT,,,,,BOTH,,,105.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEASLES IMMUNITY,101048-7,CDM,302,RC,86765,CPT,,,,,BOTH,,,17.25,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUBEOLA IGM,101472-9,CDM,302,RC,86765,CPT,,,,,BOTH,,,26,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUBELLA IMMUNITY,101046-1,CDM,302,RC,86762,CPT,,,,,BOTH,,,17.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - RUBELLA,99941-7,CDM,302,RC,86762,CPT,,,,,BOTH,,,30,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUBELLA IGM,101183-2,CDM,302,RC,86762,CPT,,,,,BOTH,,,53.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RUBELLA IGG,99478-0,CDM,302,RC,86762,CPT,,,,,BOTH,,,79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYPHUS IGG,101533-8,CDM,302,RC,86757,CPT,,,,,BOTH,,,67.95,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYPHUS IGM,101534-6,CDM,302,RC,86757,CPT,,,59,,BOTH,,,67.95,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MURINE TYPHUS,99813-8,CDM,302,RC,86757,CPT,,,,,BOTH,,,103,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,73,,13,1,167.7,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARVOVIRUS B19 IGG,99723-9,CDM,302,RC,86747,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARVOVIRUS B19 IGM,99722-1,CDM,302,RC,86747,CPT,,,,,BOTH,,,49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPLASMA PNEU PANEL/IGM,101114-7,CDM,302,RC,86738,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPLASMA PNEU PANEL/IGG,101115-4,CDM,302,RC,86738,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUMPS IMMUNITY,101047-9,CDM,302,RC,86735,CPT,,,,,BOTH,,,17.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MUMPS AB IGG,99760-1,CDM,302,RC,86735,CPT,,,,,BOTH,,,25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HAAB IGM,101064-4,CDM,302,RC,86709,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HAAB TOTAL,101063-6,CDM,302,RC,86708,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEP A AB TOTAL,99814-6,CDM,302,RC,86708,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HBE-AB,101062-8,CDM,302,RC,86707,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS BE ANTIBODY,99721-3,CDM,302,RC,86707,CPT,,,,,BOTH,,,35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HBSAG,101061-0,CDM,302,RC,86706,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HBCAB IGM,101068-5,CDM,302,RC,86705,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEP B CORE IGM,101473-7,CDM,302,RC,86705,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-HBCAB,101067-7,CDM,302,RC,86704,CPT,,,,,BOTH,,,11.25,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV-2,101266-5,CDM,302,RC,86702,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV2 SPECIFIC AB IGG,101138-6,CDM,302,RC,86696,CPT,,,,,BOTH,,,42.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV IGM PANEL (HSV2),91222-0,CDM,302,RC,86696,CPT,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV IGG PANEL (HSV2),91224-6,CDM,302,RC,86696,CPT,,,,,BOTH,,,142.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV1 SPECIFIC AB IGG,101137-8,CDM,302,RC,86695,CPT,,,,,BOTH,,,42.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV IGM PANEL (HSV1),91221-2,CDM,302,RC,86695,CPT,,,,,BOTH,,,96.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV IGG PANEL (HSV1),91223-8,CDM,302,RC,86695,CPT,,,,,BOTH,,,142.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERPES SIM I/II IGG,99515-9,CDM,302,RC,86694,CPT,,,,,BOTH,,,36.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HERPES SIM I/II IGM,99516-7,CDM,302,RC,86694,CPT,,,,,BOTH,,,37.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV WESTERN BLOT,101335-8,CDM,302,RC,86689,CPT,,,,,BOTH,,,80.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H PYLORI IGA,99729-6,CDM,302,RC,86677,CPT,,,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H PYLORI IGG,99728-8,CDM,302,RC,86677,CPT,,,,,BOTH,,,14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD-ANTIBODY FUNGUS,99980-5,CDM,302,RC,86671,CPT,,,,,BOTH,,,221,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FRANCISELLA TULARENS,99842-7,CDM,302,RC,86668,CPT,,,,,BOTH,,,354,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANAP PHAGO IGG,91241-0,CDM,302,RC,86666,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANAP PHAGO IGM,91243-6,CDM,302,RC,86666,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EHRLICHIA CHAFF IGG,91239-4,CDM,302,RC,86666,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EHRLICHIA CHAFF IGM,91240-2,CDM,302,RC,86666,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLIOVIRUS 1,101422-4,CDM,302,RC,86658,CPT,,,,,BOTH,,,137.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLIOVIRUS 2,101423-2,CDM,302,RC,86658,CPT,,,,,BOTH,,,137.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLIOVIRUS 3,101424-0,CDM,302,RC,86658,CPT,,,,,BOTH,,,137.66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ST LOUIS ENCEPHALITIS AB REPEAT,99811-2,CDM,302,RC,86653,CPT,,,91,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCCIDIODES AB,99634-8,CDM,302,RC,86635,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COCCIDIOIDES AB BY ID & CF,99471-5,CDM,302,RC,86635,CPT,,,,,BOTH,,,62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLAMYDIA PNEUMONIAE IGM,99719-7,CDM,302,RC,86632,CPT,,,,,BOTH,,,162,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLAMYDIA IGG AB,99454-1,CDM,302,RC,86631,CPT,,,,,BOTH,,,238,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANDIDA ANTIBODY,99956-5,CDM,302,RC,86628,CPT,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYME DISEASE IGM,99469-9,CDM,302,RC,86618,CPT,,,,,BOTH,,,24.9,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYME DISEASE TOTAL,99468-1,CDM,302,RC,86618,CPT,,,,,BOTH,,,24.9,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,73,,14,15,23,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYME WESTERN BLOT IGM,99715-5,CDM,302,RC,86617,CPT,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYME WESTERN BLOT IGG,99716-3,CDM,302,RC,86617,CPT,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BORDETELLA PERT. IGM,99767-6,CDM,302,RC,86615,CPT,,,,,BOTH,,,74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BORDETELLA PERT.IGG,99766-8,CDM,302,RC,86615,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLASTOMYCES AB,99633-0,CDM,302,RC,86612,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLASTOMYCES IMM DIFF,99480-6,CDM,302,RC,86612,CPT,,,,,BOTH,,,71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS FL AB,99631-4,CDM,302,RC,86606,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS FUM AB,99630-6,CDM,302,RC,86606,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS NIGER AB,99632-2,CDM,302,RC,86606,CPT,,,,,BOTH,,,23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPERGILLUS NIG,99472-3,CDM,302,RC,86606,CPT,,,,,BOTH,,,83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - RPR,99942-5,CDM,302,RC,86592,CPT,,,,,BOTH,,,12,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RA IGA,101322-6,CDM,302,RC,86431,CPT,,,,,BOTH,,,165,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RA IGG,101320-0,CDM,302,RC,86431,CPT,,,,,BOTH,,,165,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RA IGM,101321-8,CDM,302,RC,86431,CPT,,,,,BOTH,,,165,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,73,,4,3.3,4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAEMOPHILUS INFL AG,99510-0,CDM,302,RC,86403,CPT,,,,,BOTH,,,168,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LKM ANTIBODY,99834-4,CDM,302,RC,86376,CPT,,,,,BOTH,,,58,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,73,,10.5,7.5,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HELPER T-LYMPH CD4,99709-8,CDM,302,RC,86361,CPT,,,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CD4/CD8 RATIO,99772-6,CDM,302,RC,86360,CPT,,,,,BOTH,,,396,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
T CELL TOTAL COUNT,99786-6,CDM,302,RC,86359,CPT,,,,,BOTH,,,343,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MONONUCLEAR AG (B CELL PROF),99975-5,CDM,302,RC,86356,CPT,,,,,BOTH,,,216,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
L-CYTE-AG,101263-2,CDM,302,RC,86356,CPT,,,,,BOTH,,,259.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B CELL COUNT (B CELL PROFILE),99974-8,CDM,302,RC,86355,CPT,,,,,BOTH,,,216,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B CELL TOTAL COUNT,99785-8,CDM,302,RC,86355,CPT,,,,,BOTH,,,343,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIPANCREATIC ISLET,101006-5,CDM,302,RC,86341,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IA-2 AUTOANTIBODIES,101071-9,CDM,302,RC,86341,CPT,,,,,BOTH,,,156,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSULIN ANTIBODIES,101020-6,CDM,302,RC,86337,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOFIXATION FLUID,99791-6,CDM,302,RC,86335,CPT,,,,,BOTH,,,139,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H. PYLORI QL,99234-7,CDM,302,RC,86318,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLIADIN AB IGG,99912-8,CDM,302,RC,86258,CPT,,,,,BOTH,,,403,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUOR N-INF AB TITER,101204-6,CDM,302,RC,86256,CPT,,,,,BOTH,,,17.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
P-ANCA TITER,91246-9,CDM,302,RC,86256,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD-FL.NONINFECT. AB-TITER,99981-3,CDM,302,RC,86256,CPT,,,,,BOTH,,,221,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STRIATIONAL ANTIBODIES,99708-0,CDM,302,RC,86255,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC END AB,101435-6,CDM,302,RC,86255,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC-DNA AB,101227-7,CDM,302,RC,86255,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUORESCENT NONINFECT AGENT AB REPEAT,99779-1,CDM,302,RC,86255,CPT,,,91,,BOTH,,,276,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUORESCENT NONINFECT AGENT AB,99776-7,CDM,302,RC,86255,CPT,,,,,BOTH,,,276,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANA RELFEX-EXT NUCLE,101113-9,CDM,302,RC,86235,CPT,,,,,BOTH,,,28.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENDOMYSIAL AB IGA,101058-6,CDM,302,RC,86231,CPT,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SS DNA AB,99334-5,CDM,302,RC,86226,CPT,,,,,BOTH,,,283,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANA REFLEX-DNA NATIV,101112-1,CDM,302,RC,86225,CPT,,,,,BOTH,,,28.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC-IA,101226-9,CDM,302,RC,86225,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DNA AB NATIVE (DS),99367-5,CDM,302,RC,86225,CPT,,,,,BOTH,,,126,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTIDNASE B STREP,101444-8,CDM,302,RC,86215,CPT,,,,,BOTH,,,36.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CCP IGG ANTIBODY,99788-2,CDM,302,RC,86200,CPT,,,,,BOTH,,,67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C1 ESTERASE INHIB FU,101708-6,CDM,302,RC,86161,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMPLEMENT;FUNCT ACTIVITY,99711-4,CDM,302,RC,86161,CPT,,,,,BOTH,,,73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMPLEMENT;AG,99710-6,CDM,302,RC,86160,CPT,,,,,BOTH,,,32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C1Q QUANT,101257-4,CDM,302,RC,86160,CPT,,,,,BOTH,,,38.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CI ESTERASE INH TOT,101256-6,CDM,302,RC,86160,CPT,,,,,BOTH,,,41.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C2 COMPLEMENT,101197-2,CDM,302,RC,86160,CPT,,,,,BOTH,,,43.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C1 ESTERASE INHIBITO,99755-1,CDM,302,RC,86160,CPT,,,,,BOTH,,,131,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SC5B-9,101705-2,CDM,302,RC,86160,CPT,,,,,BOTH,,,139.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COLD AGGLUTININS TITER,99455-8,CDM,302,RC,86157,CPT,,,,,BOTH,,,44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C-REACT PROTEIN CARD,91225-3,CDM,302,RC,86141,CPT,,,,,BOTH,,,27,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRP,101718-5,CDM,302,RC,86140,CPT,,,,,BOTH,,,12.95,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,73,,2,2,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ATYPICAL PANCA TITER,91247-7,CDM,302,RC,86037,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C-ANCA TITER,91244-4,CDM,302,RC,86037,CPT,,,,,BOTH,,,34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLT GLYCO IA/IIA,101234-3,CDM,302,RC,86022,CPT,,,,,BOTH,,,247.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLT GLYCO IB/IX,101233-5,CDM,302,RC,86022,CPT,,,,,BOTH,,,247.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLT GLYCO IIB/IIIA,101232-7,CDM,302,RC,86022,CPT,,,,,BOTH,,,247.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLT HLAI AG,101231-9,CDM,302,RC,86022,CPT,,,,,BOTH,,,247.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEAFOOD IGE,101465-3,CDM,302,RC,86005,CPT,,,,,BOTH,,,18.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLERGEN SPEC IGE QC,101009-9,CDM,302,RC,86005,CPT,,,,,BOTH,,,28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PED A ALTERNA IGE,101485-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED C HEROA IGE,101484-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED CAT DANDER IGE,101488-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED COCKROACH IGE,101483-6,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED CODFISH IGE,101496-8,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED D FAR IGE,101487-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED DOG DANDER IGE,101489-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PEG EGG WHITE IGE,101490-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED MILK IGE,101493-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED MOUSE UR IGE,101486-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED PEANUT IGE,101491-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED SHRIMP IGE,101494-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED SOYBEAN IGE,101492-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED WALNUT IGE,101495-0,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PED WHEAT IGE,101482-8,CDM,302,RC,86003,CPT,,,,,BOTH,,,10,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
BEEF IGE,101462-0,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CHOC IGE,101464-6,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CORN IGE,101458-8,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
EGG IGE,101463-8,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
MILK IGE,101456-2,CDM,302,RC,86003,CPT,,,,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PEANUT IGE,101459-6,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PORK IGE,101461-2,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
SOYBEAN IGE,101460-4,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
WHEAT IGE,101457-0,CDM,302,RC,86003,CPT,,,76,,BOTH,,,11,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CODFISH IGE,101744-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
EGG WHITE IGE,101745-8,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
MILK IGE,101747-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PEANUT IGE,101749-0,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
SOYBEAN IGE,101748-2,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
WHEAT IGE,101746-6,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.05,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
SESAME SEED IGE,101502-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,13.77,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
BLK PEPPER ICAP,101430-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CAY PEPPER ICAP,101431-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HYMENOPTERA PROF-YELLOW JACKET VENOM,101120-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HYMENOPTERA PROF-YELLOW HORNET VENOM,101123-8,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HYMENOPTERA PROFILE-HONEYBEE VENOM,101121-2,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HYMENOPTERA PROFILE-WASP VENOM,101122-0,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HYMENOPTERA PROFILE-WHITE FACE HORNET VENOM,101124-6,CDM,302,RC,86003,CPT,,,,,BOTH,,,27,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE BF,101019-8,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE CH,101018-0,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE CO,101017-2,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE EG,101016-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE FI,101015-6,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE MI,101014-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE PE,101013-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE PK,101012-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE SB,101011-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALLERGEN SPEC IGE WH,101010-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,28,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CASEIN RAST,99961-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CATFISH ALLERGEN BY IGE,99893-0,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
COD ALLERGEN BY IGE,99891-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CORN RAST,99962-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
FLOUNDER ALLERGEN BY IGE,99898-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
MACKEREL ALLERGEN BY IGE,99890-6,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
MILK RAST,99957-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
OAT RAST,99963-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
SALMON ALLERGEN BY IGE,99895-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,32,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
LATEX IGE CAP,101425-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,48.5,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ASPERG FLAV IGE,101733-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,54.45,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PENCILLIN ALLERGEN,99909-4,CDM,302,RC,86003,CPT,,,,,BOTH,,,65,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
ALMOND IGE,101330-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
CASHEW IGE,101327-5,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
HAZELNUT IGE,101331-7,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PEANUT IGE,99835-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PECAN IGE,101325-9,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
PISTACHIO IGE,101329-1,CDM,302,RC,86003,CPT,,,,,BOTH,,,74,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
BRAZIL NUT IGE,101328-3,CDM,302,RC,86003,CPT,,,,,BOTH,,,97,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,73,,3.5,3,35,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,4,4,4,1 through 10,percent of total billed charges,,,,
FEBRILE AGGLU,91038-0,CDM,302,RC,86000,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEMOGLOBIN SOLUBILITY,99762-7,CDM,302,RC,85660,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTIME-IN PT,101655-9,CDM,302,RC,85610,CPT,,,,,BOTH,,,53,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,73,,3,2,3,34,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
HEPARIN ANTI-XA,99860-9,CDM,302,RC,85520,CPT,,,,,BOTH,,,481,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THYROGLOBULIN QUANT,99840-1,CDM,302,RC,84432,CPT,,,,,BOTH,,,335,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC TTRANS,101436-4,CDM,302,RC,83516,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC IGA,101437-2,CDM,302,RC,82784,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CELIAC-IGA,101225-1,CDM,302,RC,82784,CPT,,,,,BOTH,,,94.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETA 2 GLYCEPROTEIN,99684-3,CDM,305,RC,86146,CPT,,,,,BOTH,,,79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VISCOSITY,101466-1,CDM,305,RC,85810,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUPUS ANTICOAG-PTT SUBSTITUTION,101111-3,CDM,305,RC,85732,CPT,,,,,BOTH,,,43.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUPUS ANTICOAG-THROMB. INHIBITION,101109-7,CDM,305,RC,85705,CPT,,,,,BOTH,,,43.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"THROMBOPLASTIN INHIBITION, TISSUE",99825-2,CDM,305,RC,85705,CPT,,,,,BOTH,,,244,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUPUS ANTICOAG-THROMBIN TIME,101110-5,CDM,305,RC,85670,CPT,,,,,BOTH,,,43.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SICKLING OF RBC, REDUCTION",99705-6,CDM,305,RC,85660,CPT,,,,,BOTH,,,64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SED RATE,91056-2,CDM,305,RC,85652,CPT,,,,,BOTH,,,38,,,73,,2,2,2,38,percent of total billed charges,,,73,,2,2,2,38,percent of total billed charges,,,73,,2,2,2,38,percent of total billed charges,,,73,,2,2,2,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,1.2,2,1 through 10,percent of total billed charges,,,,
LUPUS ANTICOAG-RVVT DILUTED,101108-9,CDM,305,RC,85613,CPT,,,,,BOTH,,,43.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LYSOZYME,101403-4,CDM,305,RC,85549,CPT,,,,,BOTH,,,46.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KLEIHAUER-BETKE STAIN,99697-5,CDM,305,RC,85460,CPT,,,,,BOTH,,,174,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLASMINOGEN ACT INHIBITOR AG,99919-3,CDM,305,RC,85421,CPT,,,,,BOTH,,,420,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLASMINOGEN ACT INHIBITOR,99918-5,CDM,305,RC,85415,CPT,,,,,BOTH,,,240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PAI-1 ANTIGEN,99966-4,CDM,305,RC,85415,CPT,,,,,BOTH,,,420,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBRINOGEN ANTIGEN,99965-6,CDM,305,RC,85385,CPT,,,,,BOTH,,,233,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FIBRINOGEN ACTIVITY,99967-2,CDM,305,RC,85384,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FDP,101060-2,CDM,305,RC,85362,CPT,,,,,BOTH,,,24.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT S PROF-FREE RPT,101309-3,CDM,305,RC,85306,CPT,,,91,,BOTH,,,61.62,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT S PROF-FREE,101308-5,CDM,305,RC,85306,CPT,,,,,BOTH,,,85.36,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN S FREE,99683-5,CDM,305,RC,85305,CPT,,,,,BOTH,,,36,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT S PROF-TOTAL,101307-7,CDM,305,RC,85305,CPT,,,,,BOTH,,,61.62,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,73,,9,9,9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT C PROF-ACT,101311-9,CDM,305,RC,85303,CPT,,,,,BOTH,,,128.38,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,73,,11,11,11,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROT C PROF-AG,101310-1,CDM,305,RC,85302,CPT,,,,,BOTH,,,128.38,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTEIN C ANTIGEN,99682-7,CDM,305,RC,85302,CPT,,,,,BOTH,,,241.5,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,73,,10,10,10,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR XII ACTIVITY,99824-5,CDM,305,RC,85280,CPT,,,,,BOTH,,,584,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR XI ACTIVITY,99823-7,CDM,305,RC,85270,CPT,,,,,BOTH,,,584,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VW PROF-FACTOR AG,101237-6,CDM,305,RC,85246,CPT,,,,,BOTH,,,136.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VW PROF-FACTOR,101236-8,CDM,305,RC,85245,CPT,,,,,BOTH,,,136.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VW PROF-VIII,101235-0,CDM,305,RC,85240,CPT,,,,,BOTH,,,136.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FACTOR VII ACTIVITY,101238-4,CDM,305,RC,85230,CPT,,,,,BOTH,,,238,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET CNT AUTO,91011-7,CDM,305,RC,85049,CPT,,,,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET REPEAT,101520-5,CDM,305,RC,85049,CPT,,,91,,BOTH,,,29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RBC AUTOMATED,99687-6,CDM,305,RC,85041,CPT,,,,,BOTH,,,10,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET CNT MANUAL,90011-8,CDM,305,RC,85032,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CBC NO AUTO DIFF,99731-2,CDM,305,RC,85027,CPT,,,,,BOTH,,,19,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,73,,5,4,5,36,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,4,5,1 through 10,percent of total billed charges,,,,
PRENATAL PROF - CBC,99943-3,CDM,305,RC,85025,CPT,,,,,BOTH,,,18,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5,6,36,percent of total billed charges,,,,
CBC REPEAT,99561-3,CDM,305,RC,85025,CPT,,,91,,BOTH,,,71,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5,6,36,percent of total billed charges,,,,
CBC WITH AUTO DIFF,91001-8,CDM,305,RC,85025,CPT,,,,,BOTH,,,71,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,73,,6,4,6,201,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,5,6,36,percent of total billed charges,,,,
MANUAL BLOOD SMEAR,85008-1,CDM,305,RC,85008,CPT,,,,,BOTH,,,22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WBC MANUAL DIFFERENTIAL,99977-1,CDM,305,RC,85007,CPT,,,,,BOTH,,,6,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MANUAL DIFFERENTIAL,85007-3,CDM,305,RC,85007,CPT,,,,,BOTH,,,8,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,73,,0.5,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AUTO-DIFF,101224-4,CDM,305,RC,85004,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV GENOTYPE,101127-9,CDM,306,RC,87902,CPT,,,,,BOTH,,,512.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTERIAL AG H INF,101193-1,CDM,306,RC,87899,CPT,,,,,BOTH,,,24.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTERIAL AG NMENING,101195-6,CDM,306,RC,87899,CPT,,,,,BOTH,,,24.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTERIAL AG S PNEUM,101194-9,CDM,306,RC,87899,CPT,,,,,BOTH,,,24.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RSV ANTIBODIES,99079-6,CDM,306,RC,87807,CPT,,,QW,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BACTERIAL AG STREP B,101196-4,CDM,306,RC,87802,CPT,,,,,BOTH,,,24.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EBV PCR QUANT,101743-3,CDM,306,RC,87799,CPT,,,,,BOTH,,,230.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPSTEIN-BARR VIRUS,99917-7,CDM,306,RC,87799,CPT,,,,,BOTH,,,600,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BK QUANT PCR,101116-2,CDM,306,RC,87799,CPT,,,,,BOTH,,,726,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BK QUANT PCR-URINE,101117-0,CDM,306,RC,87799,CPT,,,,,BOTH,,,726,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOROVIRUS GI,101514-8,CDM,306,RC,87798,CPT,,,,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOROVIRUS GII,101515-5,CDM,306,RC,87798,CPT,,,59,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B. PARAPERTUSSIS PCR,101022-2,CDM,306,RC,87798,CPT,,,,,BOTH,,,179,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
B. PERTUSSIS PCR,101021-4,CDM,306,RC,87798,CPT,,,,,BOTH,,,179,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EBV PCR QUAL,101523-9,CDM,306,RC,87798,CPT,,,,,BOTH,,,328.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARVOVIRUS BLG PCR,101471-1,CDM,306,RC,87798,CPT,,,,,BOTH,,,337,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
H1N1 FLU CONFIRMATION,101036-2,CDM,306,RC,87798,CPT,,,,,BOTH,,,490,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRICH VAG AMP TECH,101529-6,CDM,306,RC,87661,CPT,,,,,BOTH,,,40,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRICH VAG DIRECT PRO,3034-6,CDM,306,RC,87660,CPT,,,,,BOTH,,,40.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GC AMPLIFICATION,101199-8,CDM,306,RC,87591,CPT,,,,,BOTH,,,24.9,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GC NAA PHARYNGEAL,101184-0,CDM,306,RC,87591,CPT,,,,,BOTH,,,32,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEISSERIA AMP TECH,101528-8,CDM,306,RC,87591,CPT,,,,,BOTH,,,40,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GONOCOCCUS AMPLIFICATION,99921-9,CDM,306,RC,87591,CPT,,,,,BOTH,,,118,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,73,,24,24,24,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RNA-PCR,101262-4,CDM,306,RC,87536,CPT,,,,,BOTH,,,300,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RNA REAL TIME PCR,99886-4,CDM,306,RC,87536,CPT,,,,,BOTH,,,425,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RNA-BDNA QUANT,101267-3,CDM,306,RC,87536,CPT,,,,,BOTH,,,550,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV 1 PCR,101339-0,CDM,306,RC,87529,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV 2 PCR,101401-8,CDM,306,RC,87529,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV RNA NAA QUAL,101503-1,CDM,306,RC,87522,CPT,,,,,BOTH,,,106.22,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HCV REFLEX GENOTYPE,101476-0,CDM,306,RC,87522,CPT,,,59,,BOTH,,,534.5,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,73,,36,36,36,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HBV-NGI ULTRAQUAL,101085-9,CDM,306,RC,87516,CPT,,,,,BOTH,,,632.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GARDNERELLA VAG D PR,3033-8,CDM,306,RC,87510,CPT,,,,,BOTH,,,40.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLU A&B PCR,101506-4,CDM,306,RC,87502,CPT,,,QW,,BOTH,,,115.8,,,73,,72,72,72,1 through 10,percent of total billed charges,,,73,,72,72,72,1 through 10,percent of total billed charges,,,73,,72,72,72,1 through 10,percent of total billed charges,,,73,,72,72,72,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENTEROVIRUS PCR,101402-6,CDM,306,RC,87498,CPT,,,,,BOTH,,,437,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV PCR CSF,101470-3,CDM,306,RC,87496,CPT,,,,,BOTH,,,223.25,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LMV PCR QUAL,101524-7,CDM,306,RC,87496,CPT,,,,,BOTH,,,223.25,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV PCR,99916-9,CDM,306,RC,87496,CPT,,,,,BOTH,,,575,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,73,,23,23,29,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLAMYDIA AMP PB TEC,101527-0,CDM,306,RC,87491,CPT,,,,,BOTH,,,40,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLAMYDIA AMPLIFICATION,99920-1,CDM,306,RC,87491,CPT,,,,,BOTH,,,118,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,73,,29,29,29,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CANDIDA DIRECT PROBE,3032-0,CDM,306,RC,87480,CPT,,,,,BOTH,,,40.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BARTONELLA DNA,101045-3,CDM,306,RC,87471,CPT,,,,,BOTH,,,450,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHIGA-LIKE TOXIN,101206-1,CDM,306,RC,87427,CPT,,,,,BOTH,,,22,,,73,,14,8,22,1 through 10,percent of total billed charges,,,73,,14,8,22,1 through 10,percent of total billed charges,,,73,,14,8,22,1 through 10,percent of total billed charges,,,73,,14,8,22,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,9,9,9,1 through 10,percent of total billed charges,,,,
COVID AG IN-HOUSE,101341-6,CDM,306,RC,87426,CPT,,,QW,,BOTH,,,66.5,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COVID ANTIGEN,101340-8,CDM,306,RC,87426,CPT,,,,,BOTH,,,66.5,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,73,,14,14,55.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ROTAVIRUS PANEL,101469-5,CDM,306,RC,87425,CPT,,,,,BOTH,,,56.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HIV 4TH,101512-2,CDM,306,RC,87389,CPT,,,,,BOTH,,,49.2,,,73,,20,20,20,1 through 10,percent of total billed charges,,,73,,20,20,20,1 through 10,percent of total billed charges,,,73,,20,20,20,1 through 10,percent of total billed charges,,,73,,20,20,20,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-INFECT AGENT HBEAG,101066-9,CDM,306,RC,87350,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAV/HBV-INFECT AGENT HBSAG,101065-1,CDM,306,RC,87340,CPT,,,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PRENATAL PROF - HBSAG,99940-9,CDM,306,RC,87340,CPT,,,,,BOTH,,,20,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
C DIFFICILE TOXIN A&B,99526-6,CDM,306,RC,87324,CPT,,,,,BOTH,,,120,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,73,,120,120,120,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOVIRUS ST PN,101468-7,CDM,306,RC,87301,CPT,,,,,BOTH,,,56.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEGIONELLA DFA,101287-1,CDM,306,RC,87278,CPT,,,,,BOTH,,,57.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CMV AG DFA,101337-4,CDM,306,RC,87271,CPT,,,,,BOTH,,,25.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BORDETELLA PERTUSSIS DFA,99979-7,CDM,306,RC,87265,CPT,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIRAL ID REFLEX,101244-2,CDM,306,RC,87255,CPT,,,,,BOTH,,,181,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIRAL SHELL VIAL TEC,101243-4,CDM,306,RC,87254,CPT,,,,,BOTH,,,140,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INDIA INK,99976-3,CDM,306,RC,87210,CPT,,,,,BOTH,,,46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
O&P SPECIAL STAIN,101202-0,CDM,306,RC,87209,CPT,,,,,BOTH,,,54.5,,,73,,42,19.5,54,1 through 10,percent of total billed charges,,,73,,42,19.5,54,1 through 10,percent of total billed charges,,,73,,42,19.5,54,1 through 10,percent of total billed charges,,,73,,42,19.5,54,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,14,14,14,1 through 10,percent of total billed charges,,,,
PARASITE EXAM-BLOOD,101069-3,CDM,306,RC,87207,CPT,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GRAM STAIN,91018-2,CDM,306,RC,87205,CPT,,,,,BOTH,,,85,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,73,,3,3,3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIC MORE THAN 3 DRUG,101131-1,CDM,306,RC,87186,CPT,,,,,BOTH,,,86.16,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6.5,6.1,6.9,1 through 10,percent of total billed charges,,,,
VABOMERE,101547-8,CDM,306,RC,87186,CPT,,,,,BOTH,,,124.25,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6.5,6.1,6.9,1 through 10,percent of total billed charges,,,,
AFB MAC SENS,101518-9,CDM,306,RC,87186,CPT,,,,,BOTH,,,173.25,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,73,,7,6,45.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6.5,6.1,6.9,1 through 10,percent of total billed charges,,,,
PINWORM PREP,101044-6,CDM,306,RC,87172,CPT,,,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARASITE ID MACROSCOPIC EXAM,99855-9,CDM,306,RC,87169,CPT,,,,,BOTH,,,30,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANISM ID SEQUENC,101517-1,CDM,306,RC,87153,CPT,,,,,BOTH,,,250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPLASMA CULTURE,99559-7,CDM,306,RC,87109,CPT,,,,,BOTH,,,38,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,73,,13,13,13,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOLD IDENTIFICATION,101300-2,CDM,306,RC,87107,CPT,,,,,BOTH,,,46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
YEAST ID,101434-9,CDM,306,RC,87106,CPT,,,,,BOTH,,,41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
YEAST CULTURE,101192-3,CDM,306,RC,87101,CPT,,,,,BOTH,,,28.2,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,73,,6,6,6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CULTURE URINE,91330-1,CDM,306,RC,87086,CPT,,,,,BOTH,,,180,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5.5,5,6,1 through 10,percent of total billed charges,,,,
CULTURE URINE REFLEX,101724-3,CDM,306,RC,87086,CPT,,,,,BOTH,,,180,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,73,,6,3.6,58.2,30,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5.5,5,6,1 through 10,percent of total billed charges,,,,
STREP CULTURE,101531-2,CDM,306,RC,87081,CPT,,,,,BOTH,,,5.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VRE SCREEN,101509-8,CDM,306,RC,87081,CPT,,,,,BOTH,,,13.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MRSA SCREEN CULTURE,101213-7,CDM,306,RC,87081,CPT,,,,,BOTH,,,38.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GC CULTURE,91231-1,CDM,306,RC,87081,CPT,,,,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRE RECTAL SCREEN,101433-1,CDM,306,RC,87081,CPT,,,,,BOTH,,,300,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANISM ID # 1,99851-8,CDM,306,RC,87077,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANISM ID #3,99853-4,CDM,306,RC,87077,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANISM ID# 2,99852-6,CDM,306,RC,87077,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORGANISM ID#4,99854-2,CDM,306,RC,87077,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLOSTRIDIUM DIFFICILE CULTURE,99968-0,CDM,306,RC,87075,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ANTHRAX SCREEN,99537-3,CDM,306,RC,87070,CPT,,,,,BOTH,,,36,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
B. PERTUSSIS CULTURE,99936-7,CDM,306,RC,87070,CPT,,,,,BOTH,,,58,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
BODY FLUID CULTURE,101680-7,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CULTURE AEROBIC,91258-4,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CULTURE BODY FLUID,99508-4,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CULTURE SPUTUM,91189-1,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CULTURE THROAT,91307-9,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
GENITAL CULTURE,101679-9,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
NASAL CULTURE,101404-2,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
PICC TIP CULTURE,101338-2,CDM,306,RC,87070,CPT,,,,,BOTH,,,180,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,73,,7,7,7,19,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
CULTURE STOOL,91181-8,CDM,306,RC,87045,CPT,,,,,BOTH,,,180,,,73,,11,6.5,180,1 through 10,percent of total billed charges,,,73,,11,6.5,180,1 through 10,percent of total billed charges,,,73,,11,6.5,180,1 through 10,percent of total billed charges,,,73,,11,6.5,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
"HSV 1,2 IGGIGM CSF",101477-8,CDM,306,RC,86694,CPT,,,,,BOTH,,,112.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HSV 1/2 IGG CSF RFX,101478-6,CDM,306,RC,86694,CPT,,,,,BOTH,,,209,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETONE DIPSTICK,99201-6,CDM,307,RC,81003,CPT,,,QW,,BOTH,,,10,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,73,,1,1,1,14,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,1,1,1,1 through 10,percent of total billed charges,,,,
URINALYSIS W/MICRO,91003-4,CDM,307,RC,81001,CPT,,,,,BOTH,,,50,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
URINALYSIS WITH MICRO REPEAT,99780-9,CDM,307,RC,81001,CPT,,,91,,BOTH,,,50,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,73,,2,1,50,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,2,2,2,1 through 10,percent of total billed charges,,,,
E-CADHERIN IMMUNOHIS,101467-9,CDM,310,RC,G0461,HCPCS,,,,,BOTH,,,46.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MICRODISSECTION MAN,3037-9,CDM,310,RC,88381,CPT,,,,,BOTH,,,125.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHOMETRIC ANLYS,3038-7,CDM,310,RC,88377,CPT,,,,,BOTH,,,130.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
M/PHMTRC ALYS ISHQUA,3030-4,CDM,310,RC,88374,CPT,,,,,BOTH,,,120.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSITU HYBRIDIZ MANU,3028-8,CDM,310,RC,88368,CPT,,,,,BOTH,,,367.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSITU HYBRIDIZ AUTO,3027-0,CDM,310,RC,88367,CPT,,,,,BOTH,,,455,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSITU HYBRIDIZATION,3026-2,CDM,310,RC,88365,CPT,,,,,BOTH,,,252.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUMOR IMMUNOHIST ADD,3029-6,CDM,310,RC,88360,CPT,,,XS,,BOTH,,,165.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TUMOR IMMUNOHIST/MAN,3025-4,CDM,310,RC,88360,CPT,,,,,BOTH,,,165.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IF IND,101289-7,CDM,310,RC,88347,CPT,,,,,BOTH,,,155.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM IF IND RPT,101290-5,CDM,310,RC,88347,CPT,,,91,,BOTH,,,155.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOFLUORESCENT ST,3024-7,CDM,310,RC,88346,CPT,,,,,BOTH,,,141.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOHISTOCHEMISTRY,3023-9,CDM,310,RC,88342,CPT,,,,,BOTH,,,145.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOHISTOCHEMISTRY,101288-9,CDM,310,RC,88342,CPT,,,59,,BOTH,,,145.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMMUNOHISTO AB SLIDE,3035-3,CDM,310,RC,88341,CPT,,,,,BOTH,,,70,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRAOP CY PATH C 2,3022-1,CDM,310,RC,88334,CPT,,,,,BOTH,,,51.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTRAOP CY PATH C 1,3021-3,CDM,310,RC,88333,CPT,,,,,BOTH,,,81.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PATH CON INTRAOP ADD,3020-5,CDM,310,RC,88332,CPT,,,,,BOTH,,,25.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PATH CON INTRAOP 1 B,3019-7,CDM,310,RC,88331,CPT,,,,,BOTH,,,74.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIAL STAIN GROUP2,3018-9,CDM,310,RC,88313,CPT,,,,,BOTH,,,154.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIAL STAIN GROUP1,3017-1,CDM,310,RC,88312,CPT,,,,,BOTH,,,187.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECALCIFY TISSUE,3016-3,CDM,310,RC,88311,CPT,,,,,BOTH,,,15.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE EX PATHOLOGIS,3015-5,CDM,310,RC,88309,CPT,,,,,BOTH,,,474.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE EX PATHOLOGIS,3014-8,CDM,310,RC,88307,CPT,,,,,BOTH,,,341.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE EX PATHOLOGIS,3013-0,CDM,310,RC,88305,CPT,,,,,BOTH,,,162.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE EX PATHOLOGIS,3012-2,CDM,310,RC,88304,CPT,,,,,BOTH,,,112.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TISSUE EX PATHOLOGIS,3011-4,CDM,310,RC,88302,CPT,,,,,BOTH,,,109.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SURGICAL PATH GROSS,3010-6,CDM,310,RC,88300,CPT,,,,,BOTH,,,52.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOWCYTOMETRY/TC ADD,3009-8,CDM,310,RC,88185,CPT,,,,,BOTH,,,116.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLOWCYTOMETRY/TC 1 M,3008-0,CDM,310,RC,88184,CPT,,,,,BOTH,,,187.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTP FNA EVAL E ADD,3007-2,CDM,310,RC,88177,CPT,,,,,BOTH,,,14.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPATH EVAL FNA RE,3006-4,CDM,310,RC,88173,CPT,,,,,BOTH,,,161.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTP DX EVAL FNA 1 S,3005-6,CDM,310,RC,88172,CPT,,,,,BOTH,,,48.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPATH SMEAR O SOU,3004-9,CDM,310,RC,88160,CPT,,,,,BOTH,,,61.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTP URINE 3-5 PROBE,3003-1,CDM,310,RC,88121,CPT,,,,,BOTH,,,789.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPATH CELL E TECH,3002-3,CDM,310,RC,88112,CPT,,,,,BOTH,,,107.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPATH CONCEN TECH,3001-5,CDM,310,RC,88108,CPT,,,,,BOTH,,,112.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYTOPATH NONGYN SMEA,3000-7,CDM,310,RC,88104,CPT,,,,,BOTH,,,87.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EGFR GENE COM VAR,3036-1,CDM,310,RC,81235,CPT,,,,,BOTH,,,329.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOLECULAR PATH,101532-0,CDM,310,RC,81229,CPT,,,,,BOTH,,,2610,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PATHOLOGY CONSULT,99229-7,CDM,310,RC,80500,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
E-CADHERIN IMMUNOHIS,3031-2,CDM,310,RC,,,,,59,,BOTH,,,58.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREEN CYTOPATH CERV,355-8,CDM,311,RC,G0123,HCPCS,,,,,BOTH,,,111,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREEN CYTOPATH CERV,181-8,CDM,311,RC,G0123,HCPCS,,,,,BOTH,,,111,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KARYOTYPE - ADDITIONAL,99658-7,CDM,311,RC,88280,CPT,,,,,BOTH,,,230,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KARYOTYPE 2ND STUDY,99659-5,CDM,311,RC,88280,CPT,,,,,BOTH,,,230,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHROMOSOME ANALYSIS 20-25 CELLS,99657-9,CDM,311,RC,88264,CPT,,,,,BOTH,,,230,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM PATH PROC,101291-3,CDM,319,RC,81479,CPT,,,,,BOTH,,,155.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IBD PROM PATH PROC,101292-1,CDM,319,RC,81479,CPT,,,91,,BOTH,,,155.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELET APH PASC,101742-5,CDM,390,RC,P9073,HCPCS,,,,,BOTH,,,796.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUMIN 25% 50ML,99678-5,CDM,390,RC,P9041,HCPCS,,,,,BOTH,,,103,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD UNIT IRR,101198-0,CDM,390,RC,P9040,HCPCS,,,,,BOTH,,,375.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELETS APH IRR,101230-1,CDM,390,RC,P9036,HCPCS,,,,,BOTH,,,936.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLATELETS PER UNIT,99011-9,CDM,390,RC,P9031,HCPCS,,,,,BOTH,,,40.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FRESH FROZEN PLASMA,99008-5,CDM,390,RC,P9017,HCPCS,,,,,BOTH,,,87.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FFP ABNEG,99003-6,CDM,390,RC,P9017,HCPCS,,,,,BOTH,,,117.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD UNIT,99006-9,CDM,390,RC,P9016,HCPCS,,,,,BOTH,,,321.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD UNIT ONEG,99002-8,CDM,390,RC,P9016,HCPCS,,,,,BOTH,,,401.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMPATIB DIRECT SPIN,91195-8,CDM,390,RC,86920,CPT,,,,,BOTH,,,142,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIRECTED DONOR FEE,99199-2,CDM,390,RC,,,,,,,BOTH,,,21.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD ADM,99525-8,CDM,391,RC,36430,CPT,,,,,BOTH,,,454,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SEQUENTIAL IV PUSH,90775-8,CDM,450,RC,96375,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,58.5,42.9,74.1,1 through 10,percent of total billed charges,,,,
IV-PUSH SINGLE/INITI,907840-3,CDM,450,RC,96374,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,39,32.6,39,1 through 10,percent of total billed charges,,,,
IV-SQ OR IM,90782-4,CDM,450,RC,96372,CPT,,,,,BOTH,,,39.13,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,39,39,39,1 through 10,percent of total billed charges,,,,
IV-EACH ADD HOUR,907682-9,CDM,450,RC,96370,CPT,,,,,BOTH,,,39.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBQ INFUSION TO 1HR,907681-1,CDM,450,RC,96369,CPT,,,,,BOTH,,,146.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV-SEQ INF TO 1 HOUR,90767-5,CDM,450,RC,96367,CPT,,,,,BOTH,,,39.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV-EACH ADD HOUR,90766-7,CDM,450,RC,96366,CPT,,,,,BOTH,,,27.01,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV-INITIAL TO 1 HOUR,90765-9,CDM,450,RC,96365,CPT,,,,,BOTH,,,146.24,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IV-EACH ADD HOUR,90761-8,CDM,450,RC,96361,CPT,,,,,BOTH,,,27.01,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,21,21,21,1 through 10,percent of total billed charges,,,,
IV-INITIAL 31MIN-1HR,810-2,CDM,450,RC,96360,CPT,,,,,BOTH,,,74.69,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ED PROC LEVEL 1,20107-9,CDM,450,RC,,,,,,,BOTH,,,242,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ED PROC LEVEL 2,20108-7,CDM,450,RC,,,,,,,BOTH,,,483,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ED PROC LEVEL 3,20109-5,CDM,450,RC,,,,,,,BOTH,,,725,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMOK/TOB CESSATION C,354-1,CDM,510,RC,G0436,HCPCS,,,,,BOTH,,,53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SMOK/TOB CESSATION C,180-0,CDM,510,RC,G0436,HCPCS,,,,,BOTH,,,53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
UNLISTED INJECTION,328-5,CDM,510,RC,96372,CPT,,,,,BOTH,,,8,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,39,39,39,1 through 10,percent of total billed charges,,,,
UNLIISTED INJECTION,178-4,CDM,510,RC,96372,CPT,,,,,BOTH,,,8,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,39,39,39,1 through 10,percent of total billed charges,,,,
EAR IRRIGATION,113-1,CDM,510,RC,69210,CPT,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EAR IRRIGATION,321-0,CDM,510,RC,69210,CPT,,,,,BOTH,,,66,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INJ MAJOR JOINT,400010-5,CDM,510,RC,20610,CPT,,,,,BOTH,,,120,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INJ MAJOR JOINT,199-0,CDM,510,RC,20610,CPT,,,,,BOTH,,,120,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EST PT OFFICE 40MIN,96078-1,CDM,513,RC,99215,CPT,,,,,BOTH,,,242,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EST PT LVL 4,96077-3,CDM,513,RC,99214,CPT,,,,,BOTH,,,132,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EST PT LVL 3,96076-5,CDM,513,RC,99213,CPT,,,,,BOTH,,,86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EST PT OFFICE 10MIN,96075-7,CDM,513,RC,99212,CPT,,,,,BOTH,,,42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EST PT 5MIN,96074-0,CDM,513,RC,99211,CPT,,,,,BOTH,,,15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PT OFFICE 60MIN,96073-2,CDM,513,RC,99205,CPT,,,,,BOTH,,,284,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PT OFFICE 45MIN,96072-4,CDM,513,RC,99204,CPT,,,,,BOTH,,,220,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PT OFFICE 30MIN,96071-6,CDM,513,RC,99203,CPT,,,,,BOTH,,,129,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PT OFFICE 20MIN,96070-8,CDM,513,RC,99202,CPT,,,,,BOTH,,,84,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PT OFFICE 10MIN,96069-0,CDM,513,RC,99201,CPT,,,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEW PATIENT EVAL PSY,96087-2,CDM,513,RC,90792,CPT,,,,,BOTH,,,346.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUMETANIDE 0.25/ML I,172075-4,CDM,636,RC,S0171,HCPCS,641600710,NDC,,,BOTH,,,1.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GRANISETRON 1MG IV,179264-7,CDM,636,RC,S0091,HCPCS,143974401,NDC,,,BOTH,,,25.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GRANISETRON 1MG SDV,172492-1,CDM,636,RC,S0091,HCPCS,17478054602,NDC,,,BOTH,,,55.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZACTAM 500MG 1GM,70124-3,CDM,636,RC,S0073,HCPCS,3256016,NDC,,,BOTH,,,40.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SULFA/TMP 800/160 V,172289-1,CDM,636,RC,S0039,HCPCS,703951403,NDC,,,BOTH,,,35.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAFCILLIN 1GM,179674-7,CDM,636,RC,S0032,HCPCS,63323032710,NDC,,,BOTH,,,41.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAFCILLIN 1GM ADV,172204-0,CDM,636,RC,S0032,HCPCS,781312892,NDC,,,BOTH,,,45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAFCILLIN 2GM,172021-8,CDM,636,RC,S0032,HCPCS,44567022210,NDC,,,BOTH,,,61.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NAFCILLIN 2GM,71649-8,CDM,636,RC,S0032,HCPCS,63323032820,NDC,,,BOTH,,,81.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMNIPAQUE 350ML,172362-6,CDM,636,RC,Q9967,HCPCS,407141476,NDC,,,BOTH,,,2.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYST0GRAFI N 30% 300M,179346-2,CDM,636,RC,Q9958,HCPCS,270014957,NDC,,,BOTH,,,1.5,,,73,,284,284,284,1 through 10,percent of total billed charges,,,73,,284,284,284,1 through 10,percent of total billed charges,,,73,,284,284,284,1 through 10,percent of total billed charges,,,73,,284,284,284,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE TRI/25-26,179478-3,CDM,636,RC,Q2038,HCPCS,49281042588,NDC,,,BOTH,,,45.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE TRI/25-26,385-5,CDM,636,RC,Q2038,HCPCS,49281042588,NDC,,,BOTH,,,45.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE TRI/25-26,195-8,CDM,636,RC,Q2038,HCPCS,49281042588,NDC,,,BOTH,,,45.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE HD/25-26,194-1,CDM,636,RC,Q2038,HCPCS,49281012588,NDC,,,BOTH,,,159.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE HD/25-26,179477-5,CDM,636,RC,Q2038,HCPCS,49281012588,NDC,,,BOTH,,,159.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUZONE HD/25-26,386-3,CDM,636,RC,Q2038,HCPCS,49281012588,NDC,,,BOTH,,,159.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SERUM ALBUMIN 25% 50 ML,99009-3,CDM,636,RC,P9047,HCPCS,,,,,BOTH,,,295,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEIN 25% 50ML,172569-6,CDM,636,RC,P9046,HCPCS,68516521601,NDC,,,BOTH,,,129.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RITUXAN 500MG/5ML,172496-2,CDM,636,RC,J9312,HCPCS,50242005306,NDC,,,BOTH,,,263.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHOTREXATE 2.5MG T,171853-5,CDM,636,RC,J8610,HCPCS,51079067005,NDC,,,BOTH,,,14.58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IPRATROP 0.02%12.5ML,179277-9,CDM,636,RC,J7644,HCPCS,378797093,NDC,,,BOTH,,,4.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BUDESONIDE INH 0.5MG,179425-4,CDM,636,RC,J7626,HCPCS,60687052483,NDC,,,BOTH,,,91.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVALBUTE 1.25MG/3ML,172213-1,CDM,636,RC,J7614,HCPCS,378699331,NDC,,,BOTH,,,1.56,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL 2.5MG 3ML,172377-4,CDM,636,RC,J7613,HCPCS,60687039579,NDC,,,BOTH,,,1.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETYLCYSTEINE 20%30,72829-5,CDM,636,RC,J7608,HCPCS,409330803,NDC,,,BOTH,,,5.07,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETYLCYSTINE 4ML20%,179775-2,CDM,636,RC,J7608,HCPCS,517760425,NDC,,,BOTH,,,34.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPREDNSLNE 4MG,179935-2,CDM,636,RC,J7509,HCPCS,68001000501,NDC,,,BOTH,,,3.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZATHIOPRINE 50MG,71848-6,CDM,636,RC,J7500,HCPCS,68084022901,NDC,,,BOTH,,,1.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KCENTRA 50GIU SDV,172667-8,CDM,636,RC,J7168,HCPCS,63833038602,NDC,,,BOTH,,,6.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHL 3% 500ML INJ,172455-8,CDM,636,RC,J7131,HCPCS,63323053021,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LR 1000NL-FRESENIUS,179248-0,CDM,636,RC,J7120,HCPCS,63323016476,NDC,,,BOTH,,,14.73,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LACTATED RING 1000,172612-4,CDM,636,RC,J7120,HCPCS,990795309,NDC,,,BOTH,,,16.27,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,73,,2,1,6.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEX 5%/WATER M CC,70617-6,CDM,636,RC,J7070,HCPCS,990792209,NDC,,,BOTH,,,14.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXTROSE 5% 100MLICU,179271-2,CDM,636,RC,J7060,HCPCS,990792323,NDC,,,BOTH,,,6.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEX 5%/WATER 500CC,70616-8,CDM,636,RC,J7060,HCPCS,338001703,NDC,,,BOTH,,,10.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SODIUM CHL 1000ML-BB,179276-1,CDM,636,RC,J7050,HCPCS,264780009,NDC,,,BOTH,,,1.84,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SOD CHL 0.9% 1000ML,172658-7,CDM,636,RC,J7050,HCPCS,990798309,NDC,,,BOTH,,,4.01,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SODIUM CHL 0.9%-50ML,172659-5,CDM,636,RC,J7050,HCPCS,338004941,NDC,,,BOTH,,,6.02,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SOD CHL INJ 250 BBRA,179278-7,CDM,636,RC,J7050,HCPCS,264780020,NDC,,,BOTH,,,6.73,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SODIUM CHL 0.9%50MLS,172657-9,CDM,636,RC,J7050,HCPCS,990798413,NDC,,,BOTH,,,6.9,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SOD CHLOR 0.9% 250ML,70639-0,CDM,636,RC,J7050,HCPCS,338004902,NDC,,,BOTH,,,10.12,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SOD CHLOR 100ML PLUS,72868-3,CDM,636,RC,J7050,HCPCS,338055318,NDC,,,BOTH,,,13.94,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
SOD CHL 50ML PLUS-BX,179249-8,CDM,636,RC,J7050,HCPCS,338055311,NDC,,,BOTH,,,14.92,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,73,,12,6,12,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
DUPIXENT 300MG/2ML,179474-2,CDM,636,RC,J3590,HCPCS,24591401,NDC,,,BOTH,,,5335.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LABETALOL 200MG/40ML,179214-2,CDM,636,RC,J3490,HCPCS,72266010301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LABETALOL 100MG-WW/H,179220-9,CDM,636,RC,J3490,HCPCS,143962201,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEDROXYPROGEST 150MG,172548-0,CDM,636,RC,J3490,HCPCS,548540000,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL 1MG 5MG V,172199-2,CDM,636,RC,J3490,HCPCS,409177805,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOPROLOL TA 5MG/5M,172643-9,CDM,636,RC,J3490,HCPCS,72611074010,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LABETALOL 100MG/ML,72814-7,CDM,636,RC,J3490,HCPCS,47781058629,NDC,,,BOTH,,,1.61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ETOMIDATE 2MG/ML INJ,172258-6,CDM,636,RC,J3490,HCPCS,55150022110,NDC,,,BOTH,,,2.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINDAMYCIN 300MG IN,172088-7,CDM,636,RC,J3490,HCPCS,25021011504,NDC,,,BOTH,,,4.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NITROGLYCERIN DP50MG,172211-5,CDM,636,RC,J3490,HCPCS,338104902,NDC,,,BOTH,,,5.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LABETALOL100MG-AKORN,179200-1,CDM,636,RC,J3490,HCPCS,17478042020,NDC,,,BOTH,,,7.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLINDAMYCIN900MG/6ML,179262-1,CDM,636,RC,J3490,HCPCS,25021011506,NDC,,,BOTH,,,13.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANEXAMIZ ACID 1000,179354-6,CDM,636,RC,J3490,HCPCS,81284061110,NDC,,,BOTH,,,15.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLYCOPYRROLATE 0.2MG,179742-2,CDM,636,RC,J3490,HCPCS,71288040704,NDC,,,BOTH,,,22.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOLIC ACID 5 MG/ML,72328-8,CDM,636,RC,J3490,HCPCS,63323018410,NDC,,,BOTH,,,137.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLEDRONIC 5ML\100ML,179399-1,CDM,636,RC,J3489,HCPCS,67457079410,NDC,,,BOTH,,,61.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZOLEDRONIC ACID 5MGB,179398-3,CDM,636,RC,J3489,HCPCS,55111068852,NDC,,,BOTH,,,168.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GEODON 10MG INJ,172148-9,CDM,636,RC,J3486,HCPCS,49392083,NDC,,,BOTH,,,766.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
D5NSW20MEQ KCL 1000B,179229-0,CDM,636,RC,J3480,HCPCS,264765200,NDC,,,BOTH,,,1.5,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS W20MEQ KCL-BRAUN,172615-7,CDM,636,RC,J3480,HCPCS,264786500,NDC,,,BOTH,,,1.5,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POT CHL 10MEQ IN50ML,179424-7,CDM,636,RC,J3480,HCPCS,338070541,NDC,,,BOTH,,,1.5,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POT CHLO 20MEQ/10ML,70899-0,CDM,636,RC,J3480,HCPCS,63323096510,NDC,,,BOTH,,,1.5,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL 2MEQ I,172269-3,CDM,636,RC,J3480,HCPCS,409665106,NDC,,,BOTH,,,1.5,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POTASSIUM CHL2MEQ/20,172270-1,CDM,636,RC,J3480,HCPCS,338070948,NDC,,,BOTH,,,1.9,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NS W20KCL 1000ML-ICU,719109-1,CDM,636,RC,J3480,HCPCS,990711509,NDC,,,BOTH,,,1.92,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXTROSE 5%LR20MEQKC,179101-1,CDM,636,RC,J3480,HCPCS,990711109,NDC,,,BOTH,,,2.46,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOD CHLOR 0.45% 20MQ,72867-5,CDM,636,RC,J3480,HCPCS,338070434,NDC,,,BOTH,,,21.71,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,73,,6,7.1,15.9,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNESIUM SULF 500MG,172193-5,CDM,636,RC,J3475,HCPCS,63323006401,NDC,,,BOTH,,,2.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNESIUM SULFATE 2G,172470-7,CDM,636,RC,J3475,HCPCS,63323010602,NDC,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MAGNESIUM SULF 1 GM,172450-9,CDM,636,RC,J3475,HCPCS,44567041024,NDC,,,BOTH,,,11.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VFEND 200MG VIAL,171954-1,CDM,636,RC,J3465,HCPCS,49319038,NDC,,,BOTH,,,169.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHYTONADIONE 10MG/ML,172308-9,CDM,636,RC,J3430,HCPCS,43598040516,NDC,,,BOTH,,,12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VITAMIN K 1MG,719122-4,CDM,636,RC,J3430,HCPCS,409915701,NDC,,,BOTH,,,12.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYANOKIT 5GM VL KIT,179567-3,CDM,636,RC,J3424,HCPCS,50633031011,NDC,,,BOTH,,,14.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYANOCOBALAMIN 1000M,106-5,CDM,636,RC,J3420,HCPCS,70069000510,NDC,,,BOTH,,,10.4,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYCNOCOBALAMIN 1000M,307-9,CDM,636,RC,J3420,HCPCS,70069000510,NDC,,,BOTH,,,10.4,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CYANOCOBALAMIN 1000M,70150-8,CDM,636,RC,J3420,HCPCS,70069000510,NDC,,,BOTH,,,10.4,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PYRIDOXINE 10MG,71308-1,CDM,636,RC,J3415,HCPCS,63323018001,NDC,,,BOTH,,,46.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THIAMINE 100MG/ML,172295-8,CDM,636,RC,J3411,HCPCS,63323001302,NDC,,,BOTH,,,13.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE 50MG/ML,172467-3,CDM,636,RC,J3410,HCPCS,517560125,NDC,,,BOTH,,,32.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROXYZINE 25MG INJ,179753-9,CDM,636,RC,J3410,HCPCS,517420125,NDC,,,BOTH,,,59.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.25GM250,179368-6,CDM,636,RC,J3375,HCPCS,70594005702,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.25GM250,179518-6,CDM,636,RC,J3375,HCPCS,70594005702,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.5GM/300,179269-6,CDM,636,RC,J3375,HCPCS,70594004301,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.5GM/300,179554-1,CDM,636,RC,J3375,HCPCS,70594004301,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.75GM350,179254-8,CDM,636,RC,J3375,HCPCS,70594005802,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.75GM350,179555-8,CDM,636,RC,J3375,HCPCS,70594005801,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 2GM/400ML,179283-7,CDM,636,RC,J3375,HCPCS,70594004402,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 2GM/400ML,179514-5,CDM,636,RC,J3375,HCPCS,70594004402,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN PM 1G/200,179564-0,CDM,636,RC,J3375,HCPCS,70594004203,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN PM 1G/200,179565-7,CDM,636,RC,J3375,HCPCS,70594004203,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.25GM IN,172561-3,CDM,636,RC,J3373,HCPCS,25021014830,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.5G INJ,179268-8,CDM,636,RC,J3373,HCPCS,409351511,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1GM INJ,172652-0,CDM,636,RC,J3373,HCPCS,63323028420,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 500MG ADV,179167-2,CDM,636,RC,J3373,HCPCS,409653411,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 500MG INJ,179363-7,CDM,636,RC,J3373,HCPCS,37457033950,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 750MG ADV,172545-6,CDM,636,RC,J3373,HCPCS,409653101,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1GM VIAL,179505-3,CDM,636,RC,J3373,HCPCS,72611076510,NDC,JW,,BOTH,,,8.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 500MG VIA,179516-0,CDM,636,RC,J3373,HCPCS,72611076110,NDC,JW,,BOTH,,,8.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 750MG,179517-8,CDM,636,RC,J3373,HCPCS,409653101,NDC,JW,,BOTH,,,20.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1.25GM,179519-4,CDM,636,RC,J3373,HCPCS,65745708239,NDC,JW,,BOTH,,,22.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1GM ADV,172152-1,CDM,636,RC,J3373,HCPCS,409653511,NDC,,,BOTH,,,29.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 1GM ADV,179515-2,CDM,636,RC,J3373,HCPCS,409653501,NDC,JW,,BOTH,,,29.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VANCOMYCIN 500MG INJ,179324-9,CDM,636,RC,J3370,HCPCS,72611076110,NDC,,,BOTH,,,8.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM 5MG INJ-PFI,172587-8,CDM,636,RC,J3360,HCPCS,409321312,NDC,,,BOTH,,,11.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM10MGSYR-DASH,179142-5,CDM,636,RC,J3360,HCPCS,69339013634,NDC,,,BOTH,,,34.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIAZEPAM 5MG INJ,172121-6,CDM,636,RC,J3360,HCPCS,409127332,NDC,,,BOTH,,,38.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STELARA 130MG/26ML V,179482-5,CDM,636,RC,J3358,HCPCS,57894005427,NDC,,,BOTH,,,43.7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KENALOG 10MG/ML 5ML,72346-0,CDM,636,RC,J3301,HCPCS,3049420,NDC,,,BOTH,,,6.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KENALOG 10 MG,102-4,CDM,636,RC,J3301,HCPCS,3029305,NDC,,,BOTH,,,6.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KENALOG 10MG,323-6,CDM,636,RC,J3301,HCPCS,3029305,NDC,,,BOTH,,,6.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KENALOG 10MG/40MG,172180-2,CDM,636,RC,J3301,HCPCS,3029305,NDC,,,BOTH,,,6.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRA 1200MG/30ML-BA,179279-5,CDM,636,RC,J3260,HCPCS,36000024201,NDC,,,BOTH,,,4.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN 80MG/2ML,179115-1,CDM,636,RC,J3260,HCPCS,67457047322,NDC,,,BOTH,,,5.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOBRAMYCIN 80 MG/2ML,72128-2,CDM,636,RC,J3260,HCPCS,63323030602,NDC,,,BOTH,,,9.51,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYGARIL 1MG INJ,172300-6,CDM,636,RC,J3243,HCPCS,8499020,NDC,,,BOTH,,,8.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TYGARIL 50MG/10ML,172687-6,CDM,636,RC,J3243,HCPCS,8499020,NDC,,,BOTH,,,441.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORPROMAZINE 25MGI,71543-3,CDM,636,RC,J3230,HCPCS,641139731,NDC,,,BOTH,,,81.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLORPROMAZINE 50MG,179370-2,CDM,636,RC,J3230,HCPCS,641139835,NDC,,,BOTH,,,92.87,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERIPARATIDE PN20MCG,172666-0,CDM,636,RC,J3110,HCPCS,47781065289,NDC,,,BOTH,,,112,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FORTEO PEN 2.4ML,172498-8,CDM,636,RC,J3110,HCPCS,2840001,NDC,,,BOTH,,,171.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERIPARATIDE 600 MCG,179539-2,CDM,636,RC,J3110,HCPCS,60505618800,NDC,,,BOTH,,,185.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TERBUTALINE 1MG/ML,70180-5,CDM,636,RC,J3105,HCPCS,143974610,NDC,,,BOTH,,,112.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TNKASE 1MG INJ,72344-5,CDM,636,RC,J3101,HCPCS,50242012047,NDC,,,BOTH,,,364.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUMATRIPTAN 6MG/0.5M,179933-7,CDM,636,RC,J3030,HCPCS,143963801,NDC,,,BOTH,,,198.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL 50MCG/ML 5M,172629-8,CDM,636,RC,J3010,HCPCS,409909335,NDC,,,BOTH,,,2.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENTANYL INJ,72072-2,CDM,636,RC,J3010,HCPCS,409909332,NDC,,,BOTH,,,4.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACTIVASE 1MG,172043-2,CDM,636,RC,J2997,HCPCS,50242008527,NDC,,,BOTH,,,246.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMNITROPE 10MG INJ-S,179301-7,CDM,636,RC,J2941,HCPCS,781300407,NDC,,,BOTH,,,350.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NORDITROPIN 15MG F/P,179246-4,CDM,636,RC,J2941,HCPCS,169770821,NDC,,,BOTH,,,411.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OMNITROPE 5MG/1.5ML,179289-4,CDM,636,RC,J2941,HCPCS,781300107,NDC,,,BOTH,,,587.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOLUMEDROL 1GM INJ,179456-9,CDM,636,RC,J2919,HCPCS,43598013074,NDC,,,BOTH,,,0.46,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 500MG INJ,179455-1,CDM,636,RC,J2919,HCPCS,43598012811,NDC,,,BOTH,,,0.62,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 125MG INJ,370-7,CDM,636,RC,J2919,HCPCS,9004722,NDC,,,BOTH,,,1.17,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 125MG INJ,179454-4,CDM,636,RC,J2919,HCPCS,9004722,NDC,,,BOTH,,,1.17,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 125MG INJ,179511-1,CDM,636,RC,J2919,HCPCS,9004722,NDC,JW,,BOTH,,,1.17,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 125MG INJ,213-9,CDM,636,RC,J2919,HCPCS,9004722,NDC,,,BOTH,,,1.17,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 40MG INJ,179453-6,CDM,636,RC,J2919,HCPCS,9003928,NDC,,,BOTH,,,2.27,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 40MG INJ,382-2,CDM,636,RC,J2919,HCPCS,9003928,NDC,,,BOTH,,,2.27,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 40MG INJ,179501-2,CDM,636,RC,J2919,HCPCS,9003928,NDC,JW,,BOTH,,,2.27,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
SOLUMEDROL 40MG INJ,214-7,CDM,636,RC,J2919,HCPCS,9003928,NDC,,,BOTH,,,2.27,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,73,,50,50,67,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,29,29,29,1 through 10,percent of total billed charges,,,,
FERRLECIT 62.5MG/5ML,179467-6,CDM,636,RC,J2916,HCPCS,24279210,NDC,,,BOTH,,,17.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERDAL 25 MG INJ,72531-7,CDM,636,RC,J2794,HCPCS,50458030611,NDC,,,BOTH,,,29.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RISPERDAL 12.5MG INJ,72532-5,CDM,636,RC,J2794,HCPCS,50458030911,NDC,,,BOTH,,,29.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RHOGAM,99342-8,CDM,636,RC,J2792,HCPCS,562780501,NDC,,,BOTH,,,202,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RHOPHYLAC 100IU,179466-8,CDM,636,RC,J2791,HCPCS,44206030001,NDC,,,BOTH,,,29.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SYNERCID IV 500MG,171938-4,CDM,636,RC,J2770,HCPCS,61570026010,NDC,,,BOTH,,,1307.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METOCLOPRAMIDE 10M I,172169-5,CDM,636,RC,J2765,HCPCS,409341401,NDC,,,BOTH,,,3.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTAMINE 10MG,172273-5,CDM,636,RC,J2720,HCPCS,63323022930,NDC,,,BOTH,,,4.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEOSTIGMINE 10ML V,172209-9,CDM,636,RC,J2710,HCPCS,641614901,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPOFAL 10MG-HOSPIR,172671-0,CDM,636,RC,J2704,HCPCS,409469930,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPOFAL 500MG/50ML,172676-9,CDM,636,RC,J2704,HCPCS,69023420,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCAINAMIDE 1000M,172160-4,CDM,636,RC,J2690,HCPCS,14789090110,NDC,,,BOTH,,,545.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCAINAMIDE1000MG/2,179465-0,CDM,636,RC,J2690,HCPCS,,,,,BOTH,,,1683.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUPHENAZINE 2.5MG,172388-1,CDM,636,RC,J2680,HCPCS,63323028110,NDC,,,BOTH,,,513.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PITOCIN 10U VIAL,71266-1,CDM,636,RC,J2590,HCPCS,63323001201,NDC,,,BOTH,,,4.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENOBARBITAL 130MG,70963-4,CDM,636,RC,J2560,HCPCS,641047725,NDC,,,BOTH,,,174.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MGINJ,120-6,CDM,636,RC,J2550,HCPCS,641092821,NDC,,,BOTH,,,5.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MGINJ,309-5,CDM,636,RC,J2550,HCPCS,641092821,NDC,,,BOTH,,,5.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROMETHAZINE 25MGINJ,71247-1,CDM,636,RC,J2550,HCPCS,641092821,NDC,,,BOTH,,,5.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPERTAZ3.375GM-WGCC,179223-3,CDM,636,RC,J2543,HCPCS,44567080210,NDC,,,BOTH,,,4.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPERACIL/TAZ 3.375M,171862-6,CDM,636,RC,J2543,HCPCS,409337813,NDC,,,BOTH,,,11.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPER/TAZ 4.5 GM,172449-1,CDM,636,RC,J2543,HCPCS,60505615900,NDC,,,BOTH,,,12.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPER/TAZ 2.25GM,172216-4,CDM,636,RC,J2543,HCPCS,60505615600,NDC,,,BOTH,,,13.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PIPER/TAZ 3.375GM,172217-2,CDM,636,RC,J2543,HCPCS,60505615700,NDC,,,BOTH,,,13.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PFIZERPEN 5M UNITS,171782-6,CDM,636,RC,J2540,HCPCS,49052083,NDC,,,BOTH,,,4.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POT.PEN G 5,000,000U",71244-8,CDM,636,RC,J2540,HCPCS,781613595,NDC,,,BOTH,,,12.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PENCILLIN G 600,000U",172262-8,CDM,636,RC,J2510,HCPCS,60793013110,NDC,,,BOTH,,,81.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEULASTA 6MG,171779-2,CDM,636,RC,J2506,HCPCS,55513019001,NDC,,,BOTH,,,1500.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INVEGA 234MG SYR-JOM,179146-6,CDM,636,RC,J2426,HCPCS,50458056401,NDC,,,BOTH,,,35.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORBACTIV 10MG UNITS,172414-5,CDM,636,RC,J2407,HCPCS,70842014003,NDC,,,BOTH,,,71.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ONDANSETRON 1MG,172034-1,CDM,636,RC,J2405,HCPCS,409475518,NDC,,,BOTH,,,1.5,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
ONDANSETRON 1MG,179502-0,CDM,636,RC,J2405,HCPCS,60505613000,NDC,JW,,BOTH,,,1.5,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,73,,9,6.6,11.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,6,6,6,1 through 10,percent of total billed charges,,,,
NESICAINE 3% 20ML,172381-6,CDM,636,RC,J2400,HCPCS,63323047827,NDC,,,BOTH,,,62.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLOROPROCAINE 3%,179331-4,CDM,636,RC,J2400,HCPCS,143921010,NDC,,,BOTH,,,122.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYLEPHRINE10MG/1M,172626-4,CDM,636,RC,J2370,HCPCS,63323075101,NDC,,,BOTH,,,8.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYLEPHRINE 10MG,172654-6,CDM,636,RC,J2370,HCPCS,70121157705,NDC,,,BOTH,,,10.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYLEPHRINE 1ML,172207-3,CDM,636,RC,J2370,HCPCS,641614225,NDC,,,BOTH,,,11.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OLANZAPINE 10MG SDV,172302-2,CDM,636,RC,J2359,HCPCS,55150030801,NDC,,,BOTH,,,4.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XOLAIR 150MG/ML PFS,179358-7,CDM,636,RC,J2357,HCPCS,50242021501,NDC,,,BOTH,,,114.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XOLAIR 75MG/0.5ML-PF,179359-5,CDM,636,RC,J2357,HCPCS,50242021401,NDC,,,BOTH,,,114.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OCTREOTIDE 0.1MG SYR,172519-1,CDM,636,RC,J2354,HCPCS,67457024501,NDC,,,BOTH,,,5.54,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SANDOSTATIN 25MCG,172037-4,CDM,636,RC,J2354,HCPCS,78018101,NDC,,,BOTH,,,18.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NALOXONE 0.4MG/ML IN,71129-1,CDM,636,RC,J2312,HCPCS,641613225,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NALOXONE 2MG/2ML SYR,172205-7,CDM,636,RC,J2312,HCPCS,76329336901,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NALBUPHINE 10MG,71196-0,CDM,636,RC,J2300,HCPCS,409146301,NDC,,,BOTH,,,9.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MORPHINE 10MG,72391-6,CDM,636,RC,J2270,HCPCS,409189301,NDC,,,BOTH,,,5.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE 10MG,179508-7,CDM,636,RC,J2270,HCPCS,409189301,NDC,JW,,BOTH,,,5.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE 4MG,171870-9,CDM,636,RC,J2270,HCPCS,409189001,NDC,,,BOTH,,,5.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE 4MG,179507-9,CDM,636,RC,J2270,HCPCS,409189001,NDC,JW,,BOTH,,,5.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE 2MG/ML INJ,72797-4,CDM,636,RC,J2270,HCPCS,409189001,NDC,,,BOTH,,,5.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE 2MG/ML INJ,179498-1,CDM,636,RC,J2270,HCPCS,409189001,NDC,JW,,BOTH,,,5.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPH SULF 2MG-FRESE,179129-2,CDM,636,RC,J2270,HCPCS,76045000411,NDC,,,BOTH,,,8.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPHINE SULF 4MG-FR,179127-6,CDM,636,RC,J2270,HCPCS,76045000511,NDC,,,BOTH,,,8.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MORPH SULF 4MG-NEXJE,179128-4,CDM,636,RC,J2270,HCPCS,409189123,NDC,,,BOTH,,,9.26,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,5,5,5,1 through 10,percent of total billed charges,,,,
MINOCIN 1MG INJ,172375-8,CDM,636,RC,J2265,HCPCS,70842016010,NDC,,,BOTH,,,2.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDAZOLAM 1MG 2ML,172201-6,CDM,636,RC,J2250,HCPCS,409230517,NDC,,,BOTH,,,2.71,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDAZOLAM 1MG 10MG,172200-8,CDM,636,RC,J2250,HCPCS,409230802,NDC,,,BOTH,,,3.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIDAZOLAM 1MG 5MG,172202-4,CDM,636,RC,J2250,HCPCS,63323041225,NDC,,,BOTH,,,8.02,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCAMINE 1MG,172350-1,CDM,636,RC,J2248,HCPCS,469321110,NDC,,,BOTH,,,5.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VABOMERE 2GM VIAL,172466-5,CDM,636,RC,J2186,HCPCS,70842012006,NDC,,,BOTH,,,5.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 1000MG TOP,179350-4,CDM,636,RC,J2185,HCPCS,55150020830,NDC,,,BOTH,,,5.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 500MG TOP,179349-6,CDM,636,RC,J2185,HCPCS,55150020720,NDC,,,BOTH,,,5.14,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 1GM/50ML-B,172697-5,CDM,636,RC,J2185,HCPCS,264318511,NDC,,,BOTH,,,6.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 1GR 100MG,172369-1,CDM,636,RC,J2185,HCPCS,55150020830,NDC,,,BOTH,,,12.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 1GR 100MG,179497-3,CDM,636,RC,J2185,HCPCS,55150020830,NDC,JW,,BOTH,,,12.16,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 500MG VIAL,172197-6,CDM,636,RC,J2185,HCPCS,55150020720,NDC,,,BOTH,,,25.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEROPENEM 500MG VIAL,179506-1,CDM,636,RC,J2185,HCPCS,55150020720,NDC,JW,,BOTH,,,25.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPERIDINE 50MG INJ,172508-4,CDM,636,RC,J2180,HCPCS,641605325,NDC,,,BOTH,,,6.73,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPERIDINE 25MG/1CC,71028-5,CDM,636,RC,J2175,HCPCS,409117630,NDC,,,BOTH,,,16.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPERIDINE 50MG/1CC,71029-3,CDM,636,RC,J2175,HCPCS,409117830,NDC,,,BOTH,,,17.34,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MEPERIDINE 100MG 1CC,71031-9,CDM,636,RC,J2175,HCPCS,409118069,NDC,,,BOTH,,,17.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MANNITOL 20% 500,172562-1,CDM,636,RC,J2150,HCPCS,990771513,NDC,,,BOTH,,,2.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MANNITOL 25% 50ML,179956-8,CDM,636,RC,J2150,HCPCS,409403101,NDC,,,BOTH,,,6.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LORAZEPAM 2MG INJ,719124-0,CDM,636,RC,J2060,HCPCS,409677802,NDC,,,BOTH,,,4.74,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZYVOX 200MG PREMIX,172304-8,CDM,636,RC,J2020,HCPCS,9514001,NDC,,,BOTH,,,44.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZYVOX IV 600MG-PFIZE,179219-1,CDM,636,RC,J2020,HCPCS,9514001,NDC,,,BOTH,,,44.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINEZOLID 600MG/300M,172253-7,CDM,636,RC,J2020,HCPCS,57664068357,NDC,,,BOTH,,,82.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINCOCIN 2CC VIAL,100-8,CDM,636,RC,J2010,HCPCS,9055501,NDC,,,BOTH,,,67.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINCOCIN 2CC VIAL,336-8,CDM,636,RC,J2010,HCPCS,9055501,NDC,,,BOTH,,,67.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LINCOCIN 2CC VIAL,70952-7,CDM,636,RC,J2010,HCPCS,9055501,NDC,,,BOTH,,,67.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDO/EPI 1%/100K20ML,172189-3,CDM,636,RC,J2004,HCPCS,409317801,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDO/EPI 1%/100K50ML,179218-3,CDM,636,RC,J2004,HCPCS,409317803,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDO 2% 20ML,179233-2,CDM,636,RC,J2003,HCPCS,409427701,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 10ML,179186-2,CDM,636,RC,J2003,HCPCS,63323020110,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 20ML,135-4,CDM,636,RC,J2003,HCPCS,409427601,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 20ML,338-4,CDM,636,RC,J2003,HCPCS,409427601,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 20ML,172188-5,CDM,636,RC,J2003,HCPCS,409427601,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 50ML,179100-3,CDM,636,RC,J2003,HCPCS,409427617,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 2% 5ML,172195-0,CDM,636,RC,J2003,HCPCS,143959401,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE MPF 1% 2ML,172194-3,CDM,636,RC,J2003,HCPCS,409471332,NDC,,,BOTH,,,1.5,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 5ML SDV,179339-7,CDM,636,RC,J2003,HCPCS,55150016205,NDC,,,BOTH,,,4.05,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XYLOCAINE-MPF 1% 2ML,179305-8,CDM,636,RC,J2003,HCPCS,63323049227,NDC,,,BOTH,,,6.26,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE MPF 2%-2ML,179344-7,CDM,636,RC,J2003,HCPCS,63323049527,NDC,,,BOTH,,,7.15,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 2% 5ML SYR,179758-8,CDM,636,RC,J2003,HCPCS,409490334,NDC,,,BOTH,,,9.93,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE MPF 1% 5ML,179312-4,CDM,636,RC,J2003,HCPCS,63323049257,NDC,,,BOTH,,,10.41,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 1% 5ML SYR,179761-2,CDM,636,RC,J2003,HCPCS,409490411,NDC,,,BOTH,,,28.49,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,73,,3,1.6,4.9,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LIDOCAINE 0.4% 500ML,70631-7,CDM,636,RC,J2002,HCPCS,338040903,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 500 PM,172185-1,CDM,636,RC,J1956,HCPCS,36000004724,NDC,,,BOTH,,,8.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 500 PM,179504-6,CDM,636,RC,J1956,HCPCS,36000004724,NDC,JW,,BOTH,,,8.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN250BAXTE,179202-7,CDM,636,RC,J1956,HCPCS,36000004624,NDC,,,BOTH,,,11.22,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 750 PM,172186-9,CDM,636,RC,J1956,HCPCS,25021013283,NDC,,,BOTH,,,12.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 750 PM,179513-7,CDM,636,RC,J1956,HCPCS,25021013283,NDC,JW,,BOTH,,,12.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOX 500MG PB,179191-2,CDM,636,RC,J1956,HCPCS,25021013282,NDC,,,BOTH,,,15.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVOFLOXACIN 250 PM,72126-6,CDM,636,RC,J1956,HCPCS,25021013281,NDC,,,BOTH,,,20.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEVETIRACETAM 10MG V,172181-0,CDM,636,RC,J1953,HCPCS,63323040005,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 20MG,72817-0,CDM,636,RC,J1940,HCPCS,409610202,NDC,,,BOTH,,,11.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 100MG INJ,172146-3,CDM,636,RC,J1938,HCPCS,143915710,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 100MG INJ,179538-4,CDM,636,RC,J1938,HCPCS,143915710,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG INJ,172149-7,CDM,636,RC,J1938,HCPCS,36000028325,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG INJ,179537-6,CDM,636,RC,J1938,HCPCS,36000028325,NDC,JW,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG INJ,200-6,CDM,636,RC,J1938,HCPCS,36000028325,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FUROSEMIDE 40MG INJ,396-2,CDM,636,RC,J1938,HCPCS,36000028325,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/30MGV,313-7,CDM,636,RC,J1885,HCPCS,409379301,NDC,,,BOTH,,,9.16,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/30MGV,132-1,CDM,636,RC,J1885,HCPCS,409379301,NDC,,,BOTH,,,9.16,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/30MGV,172182-8,CDM,636,RC,J1885,HCPCS,409379501,NDC,,,BOTH,,,9.16,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/30MGV,179499-9,CDM,636,RC,J1885,HCPCS,409379501,NDC,JW,,BOTH,,,9.16,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/60MGV,172183-6,CDM,636,RC,J1885,HCPCS,72266011801,NDC,,,BOTH,,,9.18,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KETOROLAC 15MG/60MGV,179509-5,CDM,636,RC,J1885,HCPCS,72266011801,NDC,JW,,BOTH,,,9.18,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,73,,4,4,28.8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOVOLIN N 5UNITS,172095-2,CDM,636,RC,J1815,HCPCS,169183411,NDC,,,BOTH,,,1.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOVOLIN R 5UNITS,172096-0,CDM,636,RC,J1815,HCPCS,169183311,NDC,,,BOTH,,,1.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HUMULIN R U100-5U,179374-4,CDM,636,RC,J1815,HCPCS,2821501,NDC,,,BOTH,,,2.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LANTUS 5UNITS,172099-4,CDM,636,RC,J1815,HCPCS,88222033,NDC,,,BOTH,,,3.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NOVOLOG 5UNITS,172100-0,CDM,636,RC,J1815,HCPCS,169750111,NDC,,,BOTH,,,4.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INSULIN 70/30 5 U,172097-8,CDM,636,RC,J1815,HCPCS,169183711,NDC,,,BOTH,,,19.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HUMALOG 75/25 5UNIT,172101-8,CDM,636,RC,J1815,HCPCS,2751101,NDC,,,BOTH,,,39.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROPRANOLOL 1MG/ML,171796-6,CDM,636,RC,J1800,HCPCS,143987201,NDC,,,BOTH,,,22.45,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENOFER 1MG,172305-5,CDM,636,RC,J1756,HCPCS,517234010,NDC,,,BOTH,,,3.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENOFER 1MG,179494-0,CDM,636,RC,J1756,HCPCS,517234010,NDC,JW,,BOTH,,,3.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFLIXIMAB 100MG SDV,179383-5,CDM,636,RC,J1745,HCPCS,57894016001,NDC,,,BOTH,,,133.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INFLIXIMAB 100MG SDV,179495-7,CDM,636,RC,J1745,HCPCS,57894016001,NDC,JW,,BOTH,,,133.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CORVERT 1MG/10ML INJ,172373-3,CDM,636,RC,J1742,HCPCS,9379401,NDC,,,BOTH,,,1268.94,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOLUCORTEF 100MG,172165-3,CDM,636,RC,J1720,HCPCS,9001103,NDC,,,BOTH,,,43.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYPERTET 250UNIT 1ML,71530-0,CDM,636,RC,J1670,HCPCS,13533063402,NDC,JZ,,BOTH,,,2338.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FONDAPARINUX 25MG SY,172482-2,CDM,636,RC,J1652,HCPCS,55111067802,NDC,,,BOTH,,,26.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN 10MG 30MG,172126-5,CDM,636,RC,J1650,HCPCS,548563100,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN 10MG 40MG,172127-3,CDM,636,RC,J1650,HCPCS,548563200,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN 10MG 60MG,172128-1,CDM,636,RC,J1650,HCPCS,548560300,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN 10MG/120M,172225-5,CDM,636,RC,J1650,HCPCS,548560600,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN 10MG/150M,172224-8,CDM,636,RC,J1650,HCPCS,548560700,NDC,,,BOTH,,,4.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOXAPARIN SO 40MG S,172668-6,CDM,636,RC,J1650,HCPCS,548560200,NDC,,,BOTH,,,5.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ENOX.40MGSYR-FRES-KA,179177-1,CDM,636,RC,J1650,HCPCS,63323053587,NDC,,,BOTH,,,5.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN 1000U/5000U,172176-0,CDM,636,RC,J1644,HCPCS,409272330,NDC,,,BOTH,,,1.5,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
HEPARIN 1000U/5000U,179528-5,CDM,636,RC,J1644,HCPCS,409272301,NDC,JW,,BOTH,,,1.5,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
HEPARIN 1000U/ML HOS,179122-7,CDM,636,RC,J1644,HCPCS,409272031,NDC,,,BOTH,,,1.5,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
"HEPARIN 25,000U/500M",172622-3,CDM,636,RC,J1644,HCPCS,409765113,NDC,,,BOTH,,,1.5,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
HEPARIN SOD 1000U/1M,172428-5,CDM,636,RC,J1644,HCPCS,69005802,NDC,,,BOTH,,,1.5,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
"HEP 1,000U 20ML/500M",172155-4,CDM,636,RC,J1644,HCPCS,264957710,NDC,,,BOTH,,,1.66,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
HEPARIN SOD 1000U/ML,172616-5,CDM,636,RC,J1644,HCPCS,63323054015,NDC,,,BOTH,,,2.04,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,73,,24,10.4,37.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,7,7,7,1 through 10,percent of total billed charges,,,,
HEPARIN 10UNIT FLUSH,172175-2,CDM,636,RC,J1642,HCPCS,63323054505,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN FLUSH 500-ME,179234-0,CDM,636,RC,J1642,HCPCS,63807060055,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN FLUSH 500/5,179236-5,CDM,636,RC,J1642,HCPCS,64253033335,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN FLUSH 10U/ML,179314-0,CDM,636,RC,J1642,HCPCS,64253022221,NDC,,,BOTH,,,6.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPARIN 10UNITS/ML,179872-7,CDM,636,RC,J1642,HCPCS,64253022235,NDC,,,BOTH,,,8.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL DEC 50MG,172153-9,CDM,636,RC,J1631,HCPCS,10147092205,NDC,,,BOTH,,,69.23,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HALOPERIDOL 5MG INJ,172154-7,CDM,636,RC,J1630,HCPCS,63323047401,NDC,,,BOTH,,,16.8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GLUCAGON W/DIL 1MG,70721-6,CDM,636,RC,J1610,HCPCS,597026010,NDC,,,BOTH,,,481.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN 80MG INJ,70710-9,CDM,636,RC,J1580,HCPCS,63323001002,NDC,,,BOTH,,,11.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GENTAMICIN 80MG INJT,179323-1,CDM,636,RC,J1580,HCPCS,63323001002,NDC,,,BOTH,,,11.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FOMEPIZOLE 1.5GM/1.5,179543-4,CDM,636,RC,J1451,HCPCS,70710147801,NDC,,,BOTH,,,42.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUCONAZOLE 100MG,172323-8,CDM,636,RC,J1450,HCPCS,68084072801,NDC,,,BOTH,,,56.11,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEUPOGEN 1MCG,172210-7,CDM,636,RC,J1442,HCPCS,55513092491,NDC,,,BOTH,,,3.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREMARIN VIAL 25MG,71279-4,CDM,636,RC,J1410,HCPCS,46074905,NDC,,,BOTH,,,918.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOLVALERATE10M,172583-7,CDM,636,RC,J1380,HCPCS,517042001,NDC,,,BOTH,,,35.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL VAL 100MG,349-1,CDM,636,RC,J1380,HCPCS,42023011101,NDC,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL VAL 100MG,172114-1,CDM,636,RC,J1380,HCPCS,42023011101,NDC,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ESTRADIOL VAL 100MG,193-3,CDM,636,RC,J1380,HCPCS,42023011101,NDC,,,BOTH,,,39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERYTHROCIN VIAL,70538-4,CDM,636,RC,J1364,HCPCS,409648201,NDC,,,BOTH,,,229.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ERTAPENEM 1GM/500MG,179848-7,CDM,636,RC,J1335,HCPCS,60505619604,NDC,,,BOTH,,,164.23,,,73,,191,191,215,43,percent of total billed charges,,,73,,191,191,215,43,percent of total billed charges,,,73,,191,191,215,43,percent of total billed charges,,,73,,191,191,215,43,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPTIFIBATIDE 20MG/10,172425-1,CDM,636,RC,J1327,HCPCS,70436002680,NDC,,,BOTH,,,88.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPTIFIBATIDE75MG/100,179386-8,CDM,636,RC,J1327,HCPCS,67457063110,NDC,,,BOTH,,,91.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMOTIDINE 20MG/2ML,71338-8,CDM,636,RC,J1308,HCPCS,67457043300,NDC,,,BOTH,,,2.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DOBUTAMINE 250MG/20M,70462-7,CDM,636,RC,J1250,HCPCS,409234462,NDC,,,BOTH,,,15.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHLOROTHIAZIDE 500MG,172203-2,CDM,636,RC,J1205,HCPCS,47335033040,NDC,,,BOTH,,,291.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BYDROMORPHONE 1MG CJ,179487-4,CDM,636,RC,J1171,HCPCS,409128331,NDC,,,BOTH,,,7.76,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPHONE 0.5MG,172520-9,CDM,636,RC,J1171,HCPCS,76045000905,NDC,,,BOTH,,,10.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPH 2MG/ML-VL,179316-5,CDM,636,RC,J1170,HCPCS,409336510,NDC,,,BOTH,,,4.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPHONE 2MGINJ,179909-7,CDM,636,RC,J1170,HCPCS,409131230,NDC,,,BOTH,,,6.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 250MG/50ML,172265-1,CDM,636,RC,J1165,HCPCS,641255510,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHENYTOIN 100MG 50ML,172264-4,CDM,636,RC,J1165,HCPCS,641049325,NDC,,,BOTH,,,1.95,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM 125MG INJ,172340-2,CDM,636,RC,J1163,HCPCS,25021031925,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DILTIAZEM 25MG INJ,172339-4,CDM,636,RC,J1163,HCPCS,25021031905,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIGIFAB 40MG INJ,719111-7,CDM,636,RC,J1162,HCPCS,50633012011,NDC,,,BOTH,,,11149.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDROMORPHONE 4MG,70409-8,CDM,636,RC,J1130,HCPCS,409130431,NDC,,,BOTH,,,5.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASOME 4MG/ML,172120-8,CDM,636,RC,J1100,HCPCS,63323016502,NDC,,,BOTH,,,1.5,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASONE 20MG,172631-4,CDM,636,RC,J1100,HCPCS,67457042254,NDC,,,BOTH,,,1.5,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASONE 4MG/ML,105-7,CDM,636,RC,J1100,HCPCS,63323016502,NDC,,,BOTH,,,1.5,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEXAMETHASONE 4MG/ML,319-4,CDM,636,RC,J1100,HCPCS,63323016502,NDC,,,BOTH,,,1.5,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,73,,8,8,8,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPRED 80MG/ML,311-1,CDM,636,RC,J1040,HCPCS,70121157405,NDC,,,BOTH,,,45.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPRED 80MG/ML,172650-4,CDM,636,RC,J1040,HCPCS,70121157405,NDC,,,BOTH,,,45.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
METHYLPRED 80MG/ML,201-4,CDM,636,RC,J1040,HCPCS,70121157405,NDC,,,BOTH,,,45.79,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 40MG INJ,383-0,CDM,636,RC,J1010,HCPCS,9307303,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 40MG INJ,191-7,CDM,636,RC,J1010,HCPCS,9307303,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 40MG/ML,172226-3,CDM,636,RC,J1010,HCPCS,9307303,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 40MG/ML,179500-4,CDM,636,RC,J1010,HCPCS,9937303,NDC,JW,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 80MG,70495-7,CDM,636,RC,J1010,HCPCS,9347503,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 80MG,179510-3,CDM,636,RC,J1010,HCPCS,9004722,NDC,JW,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 80MG INJ,169-3,CDM,636,RC,J1010,HCPCS,9347501,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO MEDROL 80MG INJ,384-8,CDM,636,RC,J1010,HCPCS,9347501,NDC,,,BOTH,,,1.5,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,73,,87,87,113.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEPO ESTRADIOL,72265-2,CDM,636,RC,J1000,HCPCS,9027101,NDC,,,BOTH,,,64.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROLIA 60MG,172386-5,CDM,636,RC,J0897,HCPCS,55513071001,NDC,JZ,,BOTH,,,63.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEFEROXAMINE 500MG I,179544-2,CDM,636,RC,J0895,HCPCS,63323059710,NDC,,,BOTH,,,41.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 1000U 10ESRD,172135-6,CDM,636,RC,J0886,HCPCS,59676031001,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 1000U 20ESRD,172137-2,CDM,636,RC,J0886,HCPCS,59676032004,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 2000U ESRD,172133-1,CDM,636,RC,J0886,HCPCS,59676030201,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PROCRIT 4,000U ESRD",172458-2,CDM,636,RC,J0886,HCPCS,59676030401,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PROCRIT 4,000U NESRD",172459-0,CDM,636,RC,J0886,HCPCS,59676030401,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPOGEN4000U/ML-AMGEN,179169-8,CDM,636,RC,J0885,HCPCS,55513014810,NDC,,,BOTH,,,46.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 40000JANSSEN,179227-4,CDM,636,RC,J0885,HCPCS,59676034001,NDC,,,BOTH,,,74.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 1000U 10NESR,172136-4,CDM,636,RC,J0885,HCPCS,59676031001,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 1000U20NESRD,172138-0,CDM,636,RC,J0885,HCPCS,59676032004,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCRIT 2000U NESRD,172134-9,CDM,636,RC,J0885,HCPCS,59676030201,NDC,,,BOTH,,,74.99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 100MCG ESRDA,172061-4,CDM,636,RC,J0882,HCPCS,55513000504,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 100SYR ESRDA,179131-8,CDM,636,RC,J0882,HCPCS,55513002504,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 25MCG ESRD,172412-9,CDM,636,RC,J0882,HCPCS,55513005704,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 300MCG ESRD,172058-0,CDM,636,RC,J0882,HCPCS,55513011101,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 60MCG ESRD,172479-8,CDM,636,RC,J0882,HCPCS,55513002304,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANEEP 40MCG NESRD,172544-9,CDM,636,RC,J0881,HCPCS,55513002104,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 100MCGNESRDA,172062-2,CDM,636,RC,J0881,HCPCS,55513000504,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 100SYRNESRDA,179132-6,CDM,636,RC,J0881,HCPCS,55513002504,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 25MCG NESRD,172413-7,CDM,636,RC,J0881,HCPCS,55513005704,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 300MCG NESRD,172059-8,CDM,636,RC,J0881,HCPCS,55513011101,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 40MCG ESRD,172402-0,CDM,636,RC,J0881,HCPCS,55513002104,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARANESP 60MCG NESRD,172480-6,CDM,636,RC,J0881,HCPCS,55513002304,NDC,,,BOTH,,,21.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DAPTOMYCIN 1MG INJ,172092-9,CDM,636,RC,J0878,HCPCS,67457081350,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DALVANCE 500MG VIAL,179526-9,CDM,636,RC,J0875,HCPCS,57970010001,NDC,,,BOTH,,,49.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DALVANCE 500MG VIAL,179527-7,CDM,636,RC,J0875,HCPCS,57970010001,NDC,JW,,BOTH,,,49.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SNAKE ANTIVENIN,72834-5,CDM,636,RC,J0840,HCPCS,50633011012,NDC,,,BOTH,,,17945.39,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROCHLORPERAZINE 10M,172170-3,CDM,636,RC,J0780,HCPCS,67457064099,NDC,,,BOTH,,,51.44,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CI[ROFLOXACIN 400MG,172541-5,CDM,636,RC,J0744,HCPCS,904637861,NDC,,,BOTH,,,9.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IMIPENEM/CIL 250MG,172159-6,CDM,636,RC,J0743,HCPCS,63323032225,NDC,,,BOTH,,,38.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AVYCAZ2.5GM-ALLERGAN,179172-2,CDM,636,RC,J0714,HCPCS,456270010,NDC,,,BOTH,,,256.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTAZIDIME 2GM-WGC,172094-5,CDM,636,RC,J0713,HCPCS,44567023610,NDC,,,BOTH,,,2.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTAZIDIME 1GM-PFIZ,719030-9,CDM,636,RC,J0713,HCPCS,409508216,NDC,,,BOTH,,,5.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTAZIDIME 1GM-WWCC,172086-1,CDM,636,RC,J0713,HCPCS,44567023525,NDC,,,BOTH,,,6.31,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEFLARO 10MG INJ,172161-2,CDM,636,RC,J0712,HCPCS,456040010,NDC,,,BOTH,,,14.85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TEFLARO 400MG/10MG V,179357-9,CDM,636,RC,J0712,HCPCS,456040010,NDC,,,BOTH,,,15.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 1GM,303-8,CDM,636,RC,J0696,HCPCS,25021010610,NDC,,,BOTH,,,1.68,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 1GM,163-6,CDM,636,RC,J0696,HCPCS,25021010610,NDC,,,BOTH,,,1.68,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 1GM-SARG,172694-2,CDM,636,RC,J0696,HCPCS,25021010610,NDC,,,BOTH,,,1.68,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 1GM-SARG,179503-8,CDM,636,RC,J0696,HCPCS,25021010610,NDC,JW,,BOTH,,,1.68,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MG,172028-3,CDM,636,RC,J0696,HCPCS,409733701,NDC,,,BOTH,,,2.1,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MGAV2,172032-5,CDM,636,RC,J0696,HCPCS,409733604,NDC,,,BOTH,,,2.76,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MGAV1,172031-7,CDM,636,RC,J0696,HCPCS,409733304,NDC,,,BOTH,,,2.88,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MG 2G,172030-9,CDM,636,RC,J0696,HCPCS,44567070225,NDC,,,BOTH,,,4.21,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MG 2G,179512-9,CDM,636,RC,J0696,HCPCS,44567070225,NDC,JW,,BOTH,,,4.21,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFTRIAXONE 250MG 1G,172029-1,CDM,636,RC,J0696,HCPCS,60505614800,NDC,,,BOTH,,,26.86,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,73,,78,8,124.8,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ZERBOXA,172452-5,CDM,636,RC,J0695,HCPCS,67919003001,NDC,,,BOTH,,,17.57,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFOXITIN 1GM INJ2GM,172085-3,CDM,636,RC,J0694,HCPCS,63323034225,NDC,,,BOTH,,,17.89,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFEPIME 1GM-WGCC,179240-7,CDM,636,RC,J0692,HCPCS,44567024010,NDC,,,BOTH,,,8,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFEPIME 2GM-APOTEX,179242-3,CDM,636,RC,J0692,HCPCS,60505614704,NDC,,,BOTH,,,23.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFEPIME 1GM-APOTEX,179241-5,CDM,636,RC,J0692,HCPCS,60505614604,NDC,,,BOTH,,,23.77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFAZOLIN 2GM,179326-4,CDM,636,RC,J0690,HCPCS,60505623100,NDC,,,BOTH,,,106.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
POLOCAINE 1%30ML MPF,179746-3,CDM,636,RC,J0670,HCPCS,63323026037,NDC,,,BOTH,,,6.97,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MIACALCIN 200UN 1ML,179794-3,CDM,636,RC,J0630,HCPCS,67457067502,NDC,,,BOTH,,,2805.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BICILLIN LA 100MU 6,172074-7,CDM,636,RC,J0561,HCPCS,60793070010,NDC,,,BOTH,,,46.48,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BICILLIN LA 1.2 U,333-5,CDM,636,RC,J0561,HCPCS,60793070110,NDC,,,BOTH,,,86.28,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BICILLIN LA 1.2 U,172073-9,CDM,636,RC,J0561,HCPCS,60793070110,NDC,,,BOTH,,,86.28,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BICILLIN LA 1.2 U,185-9,CDM,636,RC,J0561,HCPCS,60793070110,NDC,,,BOTH,,,86.28,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,73,,440,188,692,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BICILLIN CR 100MU 12,172072-1,CDM,636,RC,J0558,HCPCS,60793060010,NDC,,,BOTH,,,32.09,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENZTROPINE 1MG,172071-3,CDM,636,RC,J0515,HCPCS,60687036801,NDC,,,BOTH,,,87.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DICYCLOMINE 10MG INJ,172568-8,CDM,636,RC,J0500,HCPCS,17478001502,NDC,,,BOTH,,,106.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BENTYL INJ 10MG/CC,70164-9,CDM,636,RC,J0500,HCPCS,58914008052,NDC,,,BOTH,,,117.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATROPINE 0.01MG 0.4,172065-5,CDM,636,RC,J0461,HCPCS,517040125,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATROPINE 0.01MG 1MG,172066-3,CDM,636,RC,J0461,HCPCS,409163010,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATROPINE 0.5MG/5ML,172067-1,CDM,636,RC,J0461,HCPCS,409491034,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ATR SUL INJ .4MG,70100-3,CDM,636,RC,J0460,HCPCS,517040125,NDC,,,BOTH,,,3.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 500MG,179880-0,CDM,636,RC,J0456,HCPCS,69040010,NDC,,,BOTH,,,16.92,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 500MGAV,179896-6,CDM,636,RC,J0456,HCPCS,409014411,NDC,,,BOTH,,,31.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HYDRALAZINE 20MG VIA,70067-4,CDM,636,RC,J0360,HCPCS,63323061401,NDC,,,BOTH,,,36.69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCCINY;CHOLINE 200M,172641-3,CDM,636,RC,J0330,HCPCS,14789010405,NDC,,,BOTH,,,3.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUCCINYLCHOLINE 20M,172162-0,CDM,636,RC,J0330,HCPCS,409662902,NDC,,,BOTH,,,5.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN/SULB 3GM,172057-2,CDM,636,RC,J0295,HCPCS,71288000630,NDC,,,BOTH,,,11.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMP-SUL-1.5GM-SAGENT,179181-3,CDM,636,RC,J0295,HCPCS,25021014220,NDC,,,BOTH,,,15.43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN 500MG,171781-8,CDM,636,RC,J0290,HCPCS,44567010110,NDC,,,BOTH,,,8.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN 2GM,172055-6,CDM,636,RC,J0290,HCPCS,55150011420,NDC,,,BOTH,,,9.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN 2GRAM AV,179551-7,CDM,636,RC,J0290,HCPCS,781341392,NDC,,,BOTH,,,20.33,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEXTERONE 360MG PREM,179493-2,CDM,636,RC,J0283,HCPCS,,,,,BOTH,,,10.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NEXTERONE 150MG PREM,179492-4,CDM,636,RC,J0283,HCPCS,,,,,BOTH,,,19.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIODARONE 30MG INJ,172218-0,CDM,636,RC,J0282,HCPCS,143987510,NDC,,,BOTH,,,1.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMINOPHYLLINE 500MG,719130-7,CDM,636,RC,J0280,HCPCS,409592201,NDC,,,BOTH,,,12.41,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIKACIN SU 500MG/2M,179112-8,CDM,636,RC,J0278,HCPCS,23155029041,NDC,,,BOTH,,,6.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMIKACIN 100MG,172054-9,CDM,636,RC,J0278,HCPCS,703904003,NDC,,,BOTH,,,6.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPINEPHRINE 1MG/10ML,172131-5,CDM,636,RC,J0168,HCPCS,76329331801,NDC,,,BOTH,,,2.46,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPINEPHRINE 1MG/1ML,172129-9,CDM,636,RC,J0166,HCPCS,54288010301,NDC,,,BOTH,,,40.91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EPINEPHRINE 30MG/30M,179209-2,CDM,636,RC,J0165,HCPCS,76329906000,NDC,,,BOTH,,,2.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOSINE 6MG INJ,704817-6,CDM,636,RC,J0153,HCPCS,17478054202,NDC,,,BOTH,,,1.24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOSINE 6MG/2ML,172683-5,CDM,636,RC,J0153,HCPCS,63323065102,NDC,,,BOTH,,,5.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOSINE 6MG/2ML,70481-7,CDM,636,RC,J0150,HCPCS,17478054202,NDC,,,BOTH,,,17.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ADENOSINE 6MG/2ML AP,172566-2,CDM,636,RC,J0150,HCPCS,63323065102,NDC,,,BOTH,,,30.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACYCLOVIR 5MG INJ,172047-3,CDM,636,RC,J0133,HCPCS,55150018410,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETYLCYST INJ 100MG,179335-5,CDM,636,RC,J0132,HCPCS,55150025930,NDC,,,BOTH,,,13.64,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN 1000MG,172471-5,CDM,636,RC,J0131,HCPCS,63323043441,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACETAMINOPHEN 1000MG,172670-2,CDM,636,RC,J0131,HCPCS,24201010024,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ORENCIA 250 MG VIAL,179437-9,CDM,636,RC,J0129,HCPCS,3218713,NDC,,,BOTH,,,154.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VIMPAT100MG,171999-6,CDM,636,RC,C9254,HCPCS,131247860,NDC,,,BOTH,,,56.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROTONIX 40MG IV,72380-9,CDM,636,RC,C9113,HCPCS,8092351,NDC,,,BOTH,,,14.1,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRIUMPH I ACCESS PORT,82885-5,CDM,636,RC,A4301,HCPCS,,,,,BOTH,,,864,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STER WATER 20ML INJ,72844-4,CDM,636,RC,A4216,HCPCS,409488720,NDC,,,BOTH,,,3.62,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
STER WATER 50ML INJ,70646-5,CDM,636,RC,A4216,HCPCS,409488750,NDC,,,BOTH,,,6.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIKEVAX COVID 25/26,179481-7,CDM,636,RC,91322,CPT,80777011201,NDC,,,BOTH,,,331.54,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIKEVAX COVID 25/26,387-1,CDM,636,RC,91322,CPT,80777011201,NDC,,,BOTH,,,331.54,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPIKEVAX COVID 25/26,215-4,CDM,636,RC,91322,CPT,80777011201,NDC,,,BOTH,,,331.54,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,73,,331,331,331,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMOVAX,329-3,CDM,636,RC,90732,CPT,6494300,NDC,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMOVAX,209-7,CDM,636,RC,90732,CPT,6494300,NDC,,,BOTH,,,80,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMOVAX,71268-7,CDM,636,RC,90732,CPT,6494300,NDC,,,BOTH,,,328.49,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLU VACCINE 23-24,141-2,CDM,636,RC,90686,CPT,49281042388,NDC,,,BOTH,,,54.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLU VACCINE 23-24,330-1,CDM,636,RC,90686,CPT,49281042388,NDC,,,BOTH,,,54.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 20 PFS,179522-8,CDM,636,RC,90677,CPT,5200010,NDC,,,BOTH,,,733.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 20 PFS,388-9,CDM,636,RC,90677,CPT,5200010,NDC,,,BOTH,,,733.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 20 PFS,211-3,CDM,636,RC,90677,CPT,5200010,NDC,,,BOTH,,,733.63,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RABAVERT 2.5 UNIT1ML,179228-2,CDM,636,RC,90675,CPT,50632001001,NDC,,,BOTH,,,1161.32,,,73,,678,678,678,1 through 10,percent of total billed charges,,,73,,678,678,678,1 through 10,percent of total billed charges,,,73,,678,678,678,1 through 10,percent of total billed charges,,,73,,678,678,678,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 13 0.5ML,363-2,CDM,636,RC,90670,CPT,5197102,NDC,,,BOTH,,,594.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 13 0.5ML,172237-0,CDM,636,RC,90670,CPT,5197102,NDC,,,BOTH,,,594.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVNAR 13 0.5MG,210-5,CDM,636,RC,90670,CPT,5197102,NDC,,,BOTH,,,594.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HEPATITIS B VACCINE,70591-3,CDM,636,RC,90636,CPT,58160082111,NDC,,,BOTH,,,173.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
RABIES IMMUNE GLOBUL,72407-0,CDM,636,RC,90375,CPT,49281019020,NDC,,,BOTH,,,1151.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALBUTEROL 1.25MG/3ML,179443-7,CDM,636,RC,,,487990425,NDC,,,BOTH,,,2.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TACROLIMUS 0.5MG CAP,179364-5,CDM,636,RC,,,16729004101,NDC,,,BOTH,,,5.21,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VASOPRESSIN 20UN INJ,179451-0,CDM,636,RC,,,548970100,NDC,,,BOTH,,,8.42,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYCOPHENOLATE 500MG,179365-2,CDM,636,RC,,,64380072506,NDC,,,BOTH,,,9.27,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PYRAZINAMIDE 500MG,171805-5,CDM,636,RC,,,61748001211,NDC,,,BOTH,,,15.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"DRILL BIT, 3.2MM",82960-6,CDM,636,RC,,,,,,,BOTH,,,240,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SCREW, NEX FIX RES 2.7X24",82959-8,CDM,636,RC,,,,,,,BOTH,,,708,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SNAP OFF SCREW 2.7X17,82961-4,CDM,636,RC,,,,,,,BOTH,,,780,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GARDASIL 0.5ML PFS,394-7,CDM,636,RC,,,6412102,NDC,,,BOTH,,,922.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ACTIVASE 50MG,179534-3,CDM,636,RC,,,50242004413,NDC,,,BOTH,,,4400.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRONABIROL 2.5MG CAP,171777-6,CDM,637,RC,Q0167,HCPCS,60687037501,NDC,,,BOTH,,,12.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AMPICILLIN 500MG CAP,171859-2,CDM,637,RC,,,781214501,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 81MG CHEW,171909-5,CDM,637,RC,,,904679480,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
QUIETIAPINE 25MG TAB,171922-8,CDM,637,RC,,,904663861,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRAZODONE 50MG TAB,171806-3,CDM,637,RC,,,60687044311,NDC,,,BOTH,,,1.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 325MG EC TAB,171908-7,CDM,637,RC,,,536123201,NDC,,,BOTH,,,1.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASPIRIN 81MG EC TAB,171910-3,CDM,637,RC,,,69618004610,NDC,,,BOTH,,,1.75,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CIPROFLOXACIN 500MG,171989-7,CDM,637,RC,,,172531260,NDC,,,BOTH,,,2.56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DONEPEZIL 5MG TAB,171875-8,CDM,637,RC,,,904647761,NDC,,,BOTH,,,3.81,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BETHANECHOL 10MG,171972-3,CDM,637,RC,,,832051100,NDC,,,BOTH,,,4.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 250MG T,171772-7,CDM,637,RC,,,60687028201,NDC,,,BOTH,,,9.86,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEFDINIR 300MG CAP,171767-7,CDM,637,RC,,,68001036206,NDC,,,BOTH,,,11.96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AZITHROMYCIN 200/5ML,171771-9,CDM,637,RC,,,93202631,NDC,,,BOTH,,,13.59,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FENOFIBRATE 160MG TA,172000-2,CDM,637,RC,,,68084032821,NDC,,,BOTH,,,16.67,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NIMODIPINE 30MG CAP,171957-4,CDM,637,RC,,,23155010830,NDC,,,BOTH,,,22.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XARELTO 10MG TAB,171892-3,CDM,637,RC,,,50458058010,NDC,,,BOTH,,,46.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XARELTO 15MG TAB,172008-5,CDM,637,RC,,,50458057810,NDC,,,BOTH,,,46.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
XARELTO 20MG TAB,172006-9,CDM,637,RC,,,50458057910,NDC,,,BOTH,,,46.06,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAC ATS THERAPY UNIT,82927-5,CDM,761,RC,97602,CPT,,,,,BOTH,,,168,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR PUNT W/IMAG,52181-5,CDM,761,RC,62328,CPT,,,TC,,BOTH,,,766,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MYELOGRAM INJECTION,622840-7,CDM,761,RC,62284,CPT,,,,,BOTH,,,792,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ASP/INJ THYROID CYST,600010-3,CDM,761,RC,60300,CPT,,,,,BOTH,,,166,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EVALUATE GTUBE W/CON,52204-5,CDM,761,RC,49465,CPT,,,,,BOTH,,,122.82,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECLOT G-TUBE,5223-3,CDM,761,RC,49460,CPT,,,,,BOTH,,,119.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REPLACE GJ TUBE W/F,52223-5,CDM,761,RC,49452,CPT,,,,,BOTH,,,1099,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REPLACE G TUBE W/F,52203-7,CDM,761,RC,49450,CPT,,,,,BOTH,,,1099,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PARACENTESIS W/IMAGE,52215-1,CDM,761,RC,49083,CPT,,,,,BOTH,,,785.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BIOPSY OF LIVER,47100-3,CDM,761,RC,47000,CPT,,,,,BOTH,,,986,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHG GASTROSTOMY TUBE,437601-8,CDM,761,RC,43762,CPT,,,,,BOTH,,,115.93,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLUORO GUIDE NG TUBE,99154-7,CDM,761,RC,43752,CPT,,,,,BOTH,,,440,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BIOPSY INGUIN\AXILL,50329-2,CDM,761,RC,38505,CPT,,,,,BOTH,,,1426.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DECLOT DIALYSIS CATH,5215-9,CDM,761,RC,36904,CPT,,,,,BOTH,,,884.53,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLACEMT CHECKWFLOURO,5252-2,CDM,761,RC,36598,CPT,,,,,BOTH,,,69,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PICC DECLOT,99076-2,CDM,761,RC,36596,CPT,,,,,BOTH,,,403,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DIALYSIS CATH REMOVL,50331-8,CDM,761,RC,36589,CPT,,,,,BOTH,,,1086.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REPLACEMENT PICC,50330-0,CDM,761,RC,36584,CPT,,,,,BOTH,,,1888.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CATH REPLACE TUNNEL,50333-4,CDM,761,RC,36581,CPT,,,,,BOTH,,,2122.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PICC INSERTION,99152-1,CDM,761,RC,36573,CPT,,,,,BOTH,,,2147,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THORACENTESIS /TUBE,10015-6,CDM,761,RC,32555,CPT,,,,,BOTH,,,957.9,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BIOPSY OF LUNG,32095-2,CDM,761,RC,32405,CPT,,,,,BOTH,,,1100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
JOINT ASP/INJ W U/S,99172-9,CDM,761,RC,20611,CPT,,,,,BOTH,,,577.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BREAST ASPIRATION,190000-0,CDM,761,RC,19000,CPT,,,,,BOTH,,,288,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINE NDLE ASP W/O IM,277862-9,CDM,761,RC,10021,CPT,,,,,BOTH,,,170,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FINE NEEDLE ASP W/US,100220-3,CDM,761,RC,10005,CPT,,,,,BOTH,,,1250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVENT PHYS  EXAM,353-3,CDM,770,RC,G0402,HCPCS,,,,,BOTH,,,248,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PREVENT PHYS EXAM,179-2,CDM,770,RC,G0402,HCPCS,,,,,BOTH,,,248,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROSTATE CANC SCREEN,356-6,CDM,770,RC,G0102,HCPCS,,,,,BOTH,,,36.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PROSTATE CANC SCREEN,182-6,CDM,770,RC,G0102,HCPCS,,,,,BOTH,,,36.4,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CERV CANCER SCREEN,351-7,CDM,770,RC,G0101,HCPCS,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CERV CANCER SCREEN,172-7,CDM,770,RC,G0101,HCPCS,,,,,BOTH,,,56,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SOTROVIMAB INFUSION,90475-5,CDM,771,RC,M0247,HCPCS,,,,,BOTH,,,1125,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAMLAN & ETESEV INFUSION,90474-8,CDM,771,RC,M0245,HCPCS,,,,,BOTH,,,1125,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CASIRIVI/IMDEVI AD M,90473-0,CDM,771,RC,M0243,HCPCS,,,,,BOTH,,,774,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BAMLANIVIMAB ADM MON,90472-2,CDM,771,RC,M0239,HCPCS,,,,,BOTH,,,774,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMONIA ADMIN,400009-7,CDM,771,RC,G0009,HCPCS,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PNEUMONIA ADMIN,500009-6,CDM,771,RC,G0009,HCPCS,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLU ADMINISTRATION,400008-9,CDM,771,RC,G0008,HCPCS,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FLU ADMINISTRATION,500008-8,CDM,771,RC,G0008,HCPCS,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM BVL BOOSTER,3159031-8,CDM,771,RC,0134A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MOD ADM BVL BOOSTER,377-2,CDM,771,RC,0134A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA BOOSTER,3159030-0,CDM,771,RC,0064A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA BOOSTER,376-4,CDM,771,RC,0064A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA BOOSTER,205-5,CDM,771,RC,0064A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 3RD,3159029-2,CDM,771,RC,0013A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 3RD,375-6,CDM,771,RC,0013A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 3RD,204-8,CDM,771,RC,0013A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 2ND,3159028-4,CDM,771,RC,0012A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 2ND,374-9,CDM,771,RC,0012A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 2ND,203-0,CDM,771,RC,0012A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 1ST,3159027-6,CDM,771,RC,0011A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 1ST,373-1,CDM,771,RC,0011A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MODERNA ADM 1ST,202-2,CDM,771,RC,0011A,CPT,,,CS,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ADM VACCINE, EA ADDL",907420-4,CDM,771,RC,90472,CPT,,,,,BOTH,,,27.01,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ADM VACCINE, INITIAL",90471-4,CDM,771,RC,90471,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ADM VACCINE, INITIAL",381-4,CDM,771,RC,90471,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ADM VACCINE, INITIAL",184-2,CDM,771,RC,90471,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MED MANAGEMENT,96064-1,CDM,914,RC,90862,CPT,,,,,BOTH,,,144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRIRIS PSYTHPY A 30M,90840-0,CDM,914,RC,90840,CPT,,,,,BOTH,,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRISIS PSYTHPY A 30M,96086-4,CDM,914,RC,90840,CPT,,,,,BOTH,,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRISIS PSYTHPY 60 M,96085-6,CDM,914,RC,90839,CPT,,,,,BOTH,,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY E/M 60 M,96081-5,CDM,914,RC,90838,CPT,,,,,BOTH,,,566,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY 60 M,96084-9,CDM,914,RC,90837,CPT,,,,,BOTH,,,566,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY E/M 45 M,96080-7,CDM,914,RC,90836,CPT,,,,,BOTH,,,420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY 45 M,96083-1,CDM,914,RC,90834,CPT,,,,,BOTH,,,420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY E/M 30 M,96079-9,CDM,914,RC,90833,CPT,,,,,BOTH,,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
IND PSYTHPY 30 M,96082-3,CDM,914,RC,90832,CPT,,,,,BOTH,,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INDIVIDUAL 45-50,96062-5,CDM,914,RC,90806,CPT,,,,,BOTH,,,420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
MED MANAGEMENT WITH PSYCHOTHERAPY,96065-8,CDM,914,RC,90805,CPT,,,,,BOTH,,,272,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INDIVIDUAL 20-30,96063-3,CDM,914,RC,90804,CPT,,,,,BOTH,,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INITIAL PSYCH EVAL,96066-6,CDM,914,RC,90801,CPT,,,,,BOTH,,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GROUP THERAPY,96061-7,CDM,915,RC,90853,CPT,,,,,BOTH,,,145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMILY THERAPY,96059-1,CDM,916,RC,90847,CPT,,,,,BOTH,,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FAMILY THERAPY W/O,96060-9,CDM,916,RC,90846,CPT,,,,,BOTH,,,401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PSYCH TESTING,96067-4,CDM,918,RC,96130,CPT,,,,,BOTH,,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREENING PAP SMEAR,352-5,CDM,923,RC,Q0091,HCPCS,,,,,BOTH,,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SCREENING PAP SMEAR,173-5,CDM,923,RC,Q0091,HCPCS,,,,,BOTH,,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLERGY INJ 2,160-2,CDM,924,RC,95117,CPT,,,,,BOTH,,,13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLERGY INJ 2,302-0,CDM,924,RC,95117,CPT,,,,,BOTH,,,13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLERGY INJ-SINGLE,117-2,CDM,924,RC,95115,CPT,,,,,BOTH,,,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ALLERGY INJ-SINGLE,314-5,CDM,924,RC,95115,CPT,,,,,BOTH,,,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THERAPEUTIC PHLEBOTOMY-REPEAT,99789-0,CDM,940,RC,99195,CPT,,,91,,BOTH,,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
THERAPUTIC PHLEBOTOMY,99304-8,CDM,940,RC,99195,CPT,,,,,BOTH,,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLD COL FROM PIC LIN,101205-3,CDM,940,RC,36592,CPT,,,,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BLOOD COLLECT PORT,101207-9,CDM,940,RC,36591,CPT,,,,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO DIAG TOMO,730184-9,CDM,972,RC,G0279,HCPCS,,,26,,BOTH,,,71.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S VEN U-L U RT,992024-0,CDM,972,RC,93971,CPT,,,RT,,BOTH,,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S VEN U-L UN LT,730083-3,CDM,972,RC,93971,CPT,,,LT,,BOTH,,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S VENOUS U-L BI,991059-7,CDM,972,RC,93970,CPT,,,26,,BOTH,,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART UPPER LT,730032-0,CDM,972,RC,93931,CPT,,,LT,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART UPPER RT,730031-2,CDM,972,RC,93931,CPT,,,RT,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART UPPER BI,730030-4,CDM,972,RC,93930,CPT,,,26,,BOTH,,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART LOW EX LT,730036-1,CDM,972,RC,93926,CPT,,,LT,,BOTH,,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART LOW EX RT,730035-3,CDM,972,RC,93926,CPT,,,RT,,BOTH,,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ART LOWER BI,730037-9,CDM,972,RC,93925,CPT,,,26,,BOTH,,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S CAROTID,991034-0,CDM,972,RC,93880,CPT,,,26,,BOTH,,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,80,80,80,1 through 10,percent of total billed charges,,,,
PF CT BONE DENSITY,78350-6,CDM,972,RC,77078,CPT,,,26,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BONE SRVY INF <1Y,730123-7,CDM,972,RC,77076,CPT,,,26,,BOTH,,,84.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BONE SURVEY,730122-9,CDM,972,RC,77075,CPT,,,26,,BOTH,,,66.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BONE AGE,730124-5,CDM,972,RC,77072,CPT,,,26,,BOTH,,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO SCREEN U LT,730164-1,CDM,972,RC,77067,CPT,,,LT,,BOTH,,,82.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO SCREEN U RT,730165-8,CDM,972,RC,77067,CPT,,,RT,,BOTH,,,82.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO SCREEN BI,730163-3,CDM,972,RC,77067,CPT,,,26,,BOTH,,,103.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO DIAG BI,730160-9,CDM,972,RC,77066,CPT,,,26,,BOTH,,,103.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MAMMO DIAG UNI LT,730161-7,CDM,972,RC,77065,CPT,,,LT,,BOTH,,,82.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF MAMMO DIAG UNI RT,730162-5,CDM,972,RC,77065,CPT,,,RT,,BOTH,,,82.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF MAMMO SCR TOMO,730183-1,CDM,972,RC,77063,CPT,,,26,,BOTH,,,71.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT GUID NEEDLE PL,730110-4,CDM,972,RC,77012,CPT,,,26,,BOTH,,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FLOUO GU NEDLE PL,730113-8,CDM,972,RC,77002,CPT,,,26,,BOTH,,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S GU NEEDLE PL,76942-2,CDM,972,RC,76942,CPT,,,26,,BOTH,,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S EX/AX LIM RT,76873-9,CDM,972,RC,76882,CPT,,,RT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF U/S EX/AX LIM LT,76874-7,CDM,972,RC,76882,CPT,,,LT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF U/S EXT ST LIMIT,76882-0,CDM,972,RC,76882,CPT,,,26,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF U/S EX/AX LIM BI,76875-4,CDM,972,RC,76882,CPT,,,50,,BOTH,,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,68,68,68,1 through 10,percent of total billed charges,,,,
PF U/S EXTREMITY LT,730040-3,CDM,972,RC,76881,CPT,,,LT,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S EXTREMITY RT,76880-4,CDM,972,RC,76881,CPT,,,RT,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S EXTREMITY BI,730041-1,CDM,972,RC,76881,CPT,,,50,,BOTH,,,166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S SCROTUM,76831-7,CDM,972,RC,76870,CPT,,,26,,BOTH,,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S PELVIC LIMIT,730134-4,CDM,972,RC,76857,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S PELVIC TRANSA,76856-4,CDM,972,RC,76856,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S TRANSVAG,76830-9,CDM,972,RC,76830,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,206,90.8,321.2,1 through 10,percent of total billed charges,,,,
PF U/S SPINE,730159-1,CDM,972,RC,76800,CPT,,,26,,BOTH,,,130.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S RENAL,76770-7,CDM,972,RC,76770,CPT,,,26,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,350,350,350,1 through 10,percent of total billed charges,,,,
PF U/S ABD AORTA,767701-6,CDM,972,RC,76770,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,350,350,350,1 through 10,percent of total billed charges,,,,
PF U/S AAA SCREEN,730154-2,CDM,972,RC,76706,CPT,,,26,,BOTH,,,67.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S ABD LIMITED,76705-3,CDM,972,RC,76705,CPT,,,26,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,350,350,171678.5,1 through 10,percent of total billed charges,,,,
PF U/S GALLBLADDER,76833-3,CDM,972,RC,76705,CPT,,,26,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,350,350,171678.5,1 through 10,percent of total billed charges,,,,
PF U/S ABD COMPLETE,76837-4,CDM,972,RC,76700,CPT,,,26,,BOTH,,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S BRST LMT U LT,730169-0,CDM,972,RC,76642,CPT,,,LT,,BOTH,,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S BRST LMT U RT,730168-2,CDM,972,RC,76642,CPT,,,RT,,BOTH,,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S BREAST LMT BI,730170-8,CDM,972,RC,76642,CPT,,,50,,BOTH,,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S BREAST UNI LT,730126-0,CDM,972,RC,76641,CPT,,,LT,,BOTH,,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,176.5,157.7,195.3,1 through 10,percent of total billed charges,,,,
PF U/S BREAST UNI RT,76645-1,CDM,972,RC,76641,CPT,,,RT,,BOTH,,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,176.5,157.7,195.3,1 through 10,percent of total billed charges,,,,
PF U/S BREAST BI,730132-8,CDM,972,RC,76641,CPT,,,26,,BOTH,,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,176.5,157.7,195.3,1 through 10,percent of total billed charges,,,,
PF U/S CHEST,730131-0,CDM,972,RC,76604,CPT,,,26,,BOTH,,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF U/S THYROID,76536-2,CDM,972,RC,76536,CPT,,,26,,BOTH,,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ABD/CHEST CHILDFB,730193-0,CDM,972,RC,76010,CPT,,,,,BOTH,,,21.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FLOURO 1 HOUR,730125-2,CDM,972,RC,76000,CPT,,,26,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHUNTOGRAM PRO FEE,5306-6,CDM,972,RC,75809,CPT,,,26,,BOTH,,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA ABD AORTA,730143-5,CDM,972,RC,75635,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF VOIDING CYSTOGM,52063-5,CDM,972,RC,74455,CPT,,,26,,BOTH,,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RETRO URETHROGRAM,730105-4,CDM,972,RC,74450,CPT,,,26,,BOTH,,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CYSTOGRAM,74430-0,CDM,972,RC,74430,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BAR ENE W/AIR,742800-6,CDM,972,RC,74280,CPT,,,26,,BOTH,,,137,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BAR ENE W/O AIR,742700-8,CDM,972,RC,74270,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SMALL BOWEL STUDY,742500-2,CDM,972,RC,74250,CPT,,,26,,BOTH,,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SML BOWEL F/THROG,76844-0,CDM,972,RC,74248,CPT,,,26,,BOTH,,,85.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF UGI/AC W/WO ESOPH,742460-9,CDM,972,RC,74246,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF UGI W/WO ESOPHAGM,742400-5,CDM,972,RC,74240,CPT,,,26,,BOTH,,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MBS,730137-7,CDM,972,RC,74230,CPT,,,26,,BOTH,,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ESOPHAGRAM,742200-9,CDM,972,RC,74220,CPT,,,26,,BOTH,,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABPEL COMB NO,52200-3,CDM,972,RC,74178,CPT,,,26,,BOTH,,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABPEL COMB OC,730179-9,CDM,972,RC,74178,CPT,,,26,,BOTH,,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABDPEL W IV NO,52199-7,CDM,972,RC,74177,CPT,,,26,,BOTH,,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,500,329.9,31685,1 through 10,percent of total billed charges,,,,
PF CT ABPEL WO IV OC,730177-3,CDM,972,RC,74177,CPT,,,26,,BOTH,,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,500,329.9,31685,1 through 10,percent of total billed charges,,,,
PF CT ABD/PEL W IV OC,730178-1,CDM,972,RC,74177,CPT,,,26,,BOTH,,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,500,329.9,31685,1 through 10,percent of total billed charges,,,,
PF CT ABPEL WO IVNO,52198-9,CDM,972,RC,74176,CPT,,,26,,BOTH,,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,411.5,391.9,431.1,1 through 10,percent of total billed charges,,,,
PF CT ABD/PEL RENAL,730180-7,CDM,972,RC,74176,CPT,,,26,,BOTH,,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,411.5,391.9,431.1,1 through 10,percent of total billed charges,,,,
PF CTA ABDOMEN,730142-7,CDM,972,RC,74175,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA ABD/PELVIS,742801-4,CDM,972,RC,74174,CPT,,,26,,BOTH,,,193.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABD COMB IV NO,74150-4,CDM,972,RC,74170,CPT,,,26,,BOTH,,,193,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,1042,608.4,1475.6,1 through 10,percent of total billed charges,,,,
PF CT ABD COMB OC,730173-2,CDM,972,RC,74170,CPT,,,26,,BOTH,,,193,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,1042,608.4,1475.6,1 through 10,percent of total billed charges,,,,
PF CT ABD W IV NO,730135-1,CDM,972,RC,74160,CPT,,,26,,BOTH,,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABD W IV OC,730172-4,CDM,972,RC,74160,CPT,,,26,,BOTH,,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT  ABD W/O IV OC,730171-6,CDM,972,RC,74160,CPT,,,26,,BOTH,,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ABD W/O IV NO,741600-1,CDM,972,RC,74150,CPT,,,26,,BOTH,,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ABD ACU W/CHEST1V,730097-3,CDM,972,RC,74022,CPT,,,26,,BOTH,,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ABD 3V,76842-4,CDM,972,RC,74021,CPT,,,26,,BOTH,,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ABD 2V,740200-1,CDM,972,RC,74019,CPT,,,26,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,225,225,225,1 through 10,percent of total billed charges,,,,
PF ABD 1V,740000-5,CDM,972,RC,74018,CPT,,,26,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF CTA  LOWER EXT LT,730149-2,CDM,972,RC,73706,CPT,,,LT,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA LOWER EXT RT,730148-4,CDM,972,RC,73706,CPT,,,RT,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA LOWER EXT BI,730150-0,CDM,972,RC,73706,CPT,,,50,,BOTH,,,408.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX COMB LT,730093-2,CDM,972,RC,73702,CPT,,,LT,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX COMB RT,730092-4,CDM,972,RC,73702,CPT,,,RT,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EXT COM BI,730084-1,CDM,972,RC,73702,CPT,,,50,,BOTH,,,336,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX W/CO LT,730086-6,CDM,972,RC,73701,CPT,,,LT,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX W/CO RT,730085-8,CDM,972,RC,73701,CPT,,,RT,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX W/CO BI,730087-4,CDM,972,RC,73701,CPT,,,50,,BOTH,,,320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LO EX W/O C RT,730088-2,CDM,972,RC,73700,CPT,,,RT,,BOTH,,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX W/O C L,730081-7,CDM,972,RC,73700,CPT,,,LT,,BOTH,,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LOW EX W/O C B,730082-5,CDM,972,RC,73700,CPT,,,50,,BOTH,,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TOE(S),736600-8,CDM,972,RC,73660,CPT,,,26,,BOTH,,,19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CALCANEOUS/HEEL R,736500-0,CDM,972,RC,73650,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CALCANEOUS/HEL LT,730069-2,CDM,972,RC,73650,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CALCANEOUS/HEL BI,730061-9,CDM,972,RC,73650,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 3V LT,730052-8,CDM,972,RC,73630,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 3V RT,736300-5,CDM,972,RC,73630,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 3V BI,730053-6,CDM,972,RC,73630,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 2V LT,730007-2,CDM,972,RC,73620,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 2V RT,736200-7,CDM,972,RC,73620,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOOT 2V BI,730008-0,CDM,972,RC,73620,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ANKLE 3V LT,730059-3,CDM,972,RC,73610,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ANKLE 3V RT,736100-9,CDM,972,RC,73610,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ANKLE 3V BI,730060-1,CDM,972,RC,73610,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ANKLE 2V LT,730005-6,CDM,972,RC,73600,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ANKLE 2V RT,736000-1,CDM,972,RC,73600,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ANKLE 2V BI,730006-4,CDM,972,RC,73600,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT LWR EXT BI,730189-8,CDM,972,RC,73592,CPT,,,50,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT LWR EXT LT,730187-2,CDM,972,RC,73592,CPT,,,LT,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT LWR EXT RT,730188-0,CDM,972,RC,73592,CPT,,,RT,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TIBIA/FIBULA LT,730080-9,CDM,972,RC,73590,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TIBIA/FIBULA RT,735900-3,CDM,972,RC,73590,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TIBIA/FIBULA BI,730074-2,CDM,972,RC,73590,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 4V LT,730072-6,CDM,972,RC,73564,CPT,,,LT,,BOTH,,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 4V RT,730181-5,CDM,972,RC,73564,CPT,,,RT,,BOTH,,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 4V BI,730073-4,CDM,972,RC,73564,CPT,,,50,,BOTH,,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 3V LT,730038-7,CDM,972,RC,73562,CPT,,,LT,,BOTH,,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 3V RT,735620-7,CDM,972,RC,73562,CPT,,,RT,,BOTH,,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 3V BI,730039-5,CDM,972,RC,73562,CPT,,,26,,BOTH,,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 1 OR  2V LT,730067-6,CDM,972,RC,73560,CPT,,,LT,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 1 OR 2V RT,735600-9,CDM,972,RC,73560,CPT,,,RT,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF KNEE 1 OR 2V BI,730068-4,CDM,972,RC,73560,CPT,,,26,,BOTH,,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 2V LT,730055-1,CDM,972,RC,73552,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 2V RT,735500-1,CDM,972,RC,73552,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 2V BI,730056-9,CDM,972,RC,73552,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 1V LT,76886-1,CDM,972,RC,73551,CPT,,,26,,BOTH,,,20.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 1V RT,76885-3,CDM,972,RC,73551,CPT,,,26,,BOTH,,,20.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FEMUR 1V BI,76883-8,CDM,972,RC,73551,CPT,,,26,,BOTH,,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HIP 2V BI,735200-8,CDM,972,RC,73521,CPT,,,26,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HIP 2V  LT,730047-8,CDM,972,RC,73502,CPT,,,LT,,BOTH,,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,236,236,236,1 through 10,percent of total billed charges,,,,
PF HIP 2V W/WO PEL R,735100-0,CDM,972,RC,73502,CPT,,,RT,,BOTH,,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,236,236,236,1 through 10,percent of total billed charges,,,,
PF HIP 1V W/WO PEL L,730010-6,CDM,972,RC,73501,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HIP 1V W/WO PEL R,735000-2,CDM,972,RC,73501,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA UPPER EXT LT,730146-8,CDM,972,RC,73206,CPT,,,LT,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA UPPER EXT RT,730145-0,CDM,972,RC,73206,CPT,,,RT,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA UPPER EXT BI,730147-6,CDM,972,RC,73206,CPT,,,26,,BOTH,,,408.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT COM LT,730026-2,CDM,972,RC,73202,CPT,,,LT,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT COM RT,730025-4,CDM,972,RC,73202,CPT,,,RT,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT COMB BI,730027-0,CDM,972,RC,73202,CPT,,,26,,BOTH,,,336,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT W/CO L,730070-0,CDM,972,RC,73201,CPT,,,LT,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT W/CO R,730077-5,CDM,972,RC,73201,CPT,,,RT,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UPP EXT W/CO B,730071-8,CDM,972,RC,73201,CPT,,,26,,BOTH,,,320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UP EX W/O C LT,730090-8,CDM,972,RC,73200,CPT,,,LT,,BOTH,,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UP EX W/O C RT,730089-0,CDM,972,RC,73200,CPT,,,RT,,BOTH,,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT UP EX W/O C BI,730091-6,CDM,972,RC,73200,CPT,,,26,,BOTH,,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FINGER 2V,731400-8,CDM,972,RC,73140,CPT,,,26,,BOTH,,,19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HAND 3V LT,730045-2,CDM,972,RC,73130,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,157,158.8,173.2,1 through 10,percent of total billed charges,,,,
PF HAND 3V RT,731300-0,CDM,972,RC,73130,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,157,158.8,173.2,1 through 10,percent of total billed charges,,,,
PF HAND 3V  BI,730046-0,CDM,972,RC,73130,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,157,158.8,173.2,1 through 10,percent of total billed charges,,,,
PF HAND 2V LT,730013-0,CDM,972,RC,73120,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HAND 2V RT,730012-2,CDM,972,RC,73120,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HAND 2V BI,730014-8,CDM,972,RC,73120,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF WRIST 3V LT,730075-9,CDM,972,RC,73110,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,142.5,116.5,168.5,1 through 10,percent of total billed charges,,,,
PF WRIST 3V RT,731100-4,CDM,972,RC,73110,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,142.5,116.5,168.5,1 through 10,percent of total billed charges,,,,
PF WRSIT 3V BI,730076-7,CDM,972,RC,73110,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,142.5,116.5,168.5,1 through 10,percent of total billed charges,,,,
PF WRIST 2V LT,730020-5,CDM,972,RC,73100,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF WRIST 2V RT,730019-7,CDM,972,RC,73100,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF WRIST  2V BI,730021-3,CDM,972,RC,73100,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT UPR EXT  BI,730192-2,CDM,972,RC,73092,CPT,,,50,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT UPR EXT LT,730190-6,CDM,972,RC,73092,CPT,,,LT,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INFANT UPR EXT RT,730191-4,CDM,972,RC,73092,CPT,,,RT,,BOTH,,,71.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOREARM 2V LT,730050-2,CDM,972,RC,73090,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOREARM 2V RT,730900-8,CDM,972,RC,73090,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FOREARM 2V BI,730051-0,CDM,972,RC,73090,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ELBOW 3V LT,730066-8,CDM,972,RC,73080,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ELBOW 3V RT,730800-0,CDM,972,RC,73080,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ELBOW 3V BI,730054-4,CDM,972,RC,73080,CPT,,,50,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ELBOW 2V LT,730003-1,CDM,972,RC,73070,CPT,,,LT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ELBOW 2V RT,730009-8,CDM,972,RC,73070,CPT,,,RT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ELBOW 2V BI,730004-9,CDM,972,RC,73070,CPT,,,50,,BOTH,,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF HUMERUS 2V LT,730043-7,CDM,972,RC,73060,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF HUMERUS 2V RT,730600-4,CDM,972,RC,73060,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF HUMERUS 2V  BI,730044-5,CDM,972,RC,73060,CPT,,,26,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF AC JOINTS,730096-5,CDM,972,RC,73050,CPT,,,26,,BOTH,,,21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ARTHROGM SHOLER2V,73040-8,CDM,972,RC,73040,CPT,,,26,,BOTH,,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SHOULDER 2V LT,730078-3,CDM,972,RC,73030,CPT,,,LT,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,221.8,1 through 10,percent of total billed charges,,,,
PF SHOULDER 2V RT,730300-1,CDM,972,RC,73030,CPT,,,RT,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,221.8,1 through 10,percent of total billed charges,,,,
PF SHOULDER 2V BI,730079-1,CDM,972,RC,73030,CPT,,,26,,BOTH,,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,221.8,1 through 10,percent of total billed charges,,,,
PF SHOULDER 1V LT,730022-1,CDM,972,RC,73020,CPT,,,LT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SHOULDER 1V RT,730200-3,CDM,972,RC,73020,CPT,,,RT,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SHOULDER 1V BI,730015-5,CDM,972,RC,73020,CPT,,,26,,BOTH,,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SCAPULA RT,730100-5,CDM,972,RC,73010,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SCAPULA UNI LT,730057-7,CDM,972,RC,73010,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SCAPULA BI,730058-5,CDM,972,RC,73010,CPT,,,50,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CLAVICLE LT,730064-3,CDM,972,RC,73000,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CLAVICLE RT,730000-7,CDM,972,RC,73000,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CLAVICLE BI,730065-0,CDM,972,RC,73000,CPT,,,50,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MYELOGRAM LUMBAR,722650-9,CDM,972,RC,72265,CPT,,,26,,BOTH,,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MYELOGRAM THORAC,730115-3,CDM,972,RC,72255,CPT,,,26,,BOTH,,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MYELOGRAM CERVICA,722400-9,CDM,972,RC,72240,CPT,,,26,,BOTH,,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SACRUM/COCCYX,722200-3,CDM,972,RC,72220,CPT,,,26,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SI JOINTS,722020-5,CDM,972,RC,72202,CPT,,,26,,BOTH,,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PEL COMB IV NO,721940-5,CDM,972,RC,72194,CPT,,,26,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PELVIS COMB OC,730176-5,CDM,972,RC,72194,CPT,,,26,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PEL W IV NO,721930-6,CDM,972,RC,72193,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PEL W/O IV OC,730174-0,CDM,972,RC,72193,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PELVIS W IV OC,730175-7,CDM,972,RC,72193,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT PEL W/O IV NO,72192-8,CDM,972,RC,72192,CPT,,,26,,BOTH,,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA PELVIS,730144-3,CDM,972,RC,72191,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF PELVIS,721700-3,CDM,972,RC,72170,CPT,,,26,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LUMBAR COMBINE,721330-9,CDM,972,RC,72133,CPT,,,26,,BOTH,,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LUMBAR W/CONT,730136-9,CDM,972,RC,72132,CPT,,,26,,BOTH,,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT LUMBAR W/O,721310-1,CDM,972,RC,72131,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT THORACIC COMBD,722201-1,CDM,972,RC,72130,CPT,,,26,,BOTH,,,156.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT THORACIC W/O,721280-6,CDM,972,RC,72128,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CERVICAL WITH,76843-2,CDM,972,RC,72126,CPT,,,26,,BOTH,,,150.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CERVICAL W/O,721250-9,CDM,972,RC,72125,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF LUMBAR 6V,730094-0,CDM,972,RC,72114,CPT,,,26,,BOTH,,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF LUMBAR 4V,721100-6,CDM,972,RC,72110,CPT,,,26,,BOTH,,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF LUMBAR 2 OR 3V,721000-8,CDM,972,RC,72100,CPT,,,26,,BOTH,,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF ALL SPINE,76881-2,CDM,972,RC,72082,CPT,,,26,,BOTH,,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,157,157,157,1 through 10,percent of total billed charges,,,,
PF SCOLIOSIS,76884-6,CDM,972,RC,72081,CPT,,,26,,BOTH,,,32.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF THORACIC 3V,730049-4,CDM,972,RC,72072,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF THORACIC 2V,720700-4,CDM,972,RC,72070,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CERVICAL 6V,720520-6,CDM,972,RC,72052,CPT,,,26,,BOTH,,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CERVICAL 4 OR 5V,720500-8,CDM,972,RC,72050,CPT,,,26,,BOTH,,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CERVICAL 2 OR 3V,720400-1,CDM,972,RC,72040,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SPINE 1V,52201-1,CDM,972,RC,72020,CPT,,,26,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA CHEST,730141-9,CDM,972,RC,71275,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CHEST LOW DOSE,730194-8,CDM,972,RC,71271,CPT,,,26,,BOTH,,,126.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CHEST COMBINED,712700-4,CDM,972,RC,71270,CPT,,,26,,BOTH,,,191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CHEST WITH,712601-4,CDM,972,RC,71260,CPT,,,26,,BOTH,,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT CHEST W/O,7122701-1,CDM,972,RC,71250,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SC JOINTS,711300-4,CDM,972,RC,71130,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF STERNUM,711200-6,CDM,972,RC,71120,CPT,,,26,,BOTH,,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS BI W/1V CXR,730063-5,CDM,972,RC,71111,CPT,,,26,,BOTH,,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS 2V BI,730099-9,CDM,972,RC,71110,CPT,,,26,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS LT W/1V CXR,730062-7,CDM,972,RC,71101,CPT,,,LT,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS RT W/1V CXR,711010-9,CDM,972,RC,71101,CPT,,,RT,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS 2V UNI LT,730098-1,CDM,972,RC,71100,CPT,,,LT,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RIBS RT,711000-0,CDM,972,RC,71100,CPT,,,RT,,BOTH,,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CHEST 4V,710300-5,CDM,972,RC,71048,CPT,,,26,,BOTH,,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CHEST 3V,710210-6,CDM,972,RC,71047,CPT,,,26,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CHEST 2V,710200-7,CDM,972,RC,71046,CPT,,,26,,BOTH,,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,157,2979.8,1 through 10,percent of total billed charges,,,,
PF CHEST 1V,710100-9,CDM,972,RC,71045,CPT,,,26,,BOTH,,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,175,175,175,1 through 10,percent of total billed charges,,,,
PF CTA NECK,730140-1,CDM,972,RC,70498,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CTA HEAD,730139-3,CDM,972,RC,70496,CPT,,,26,,BOTH,,,204.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT NECK COMBINED,704920-8,CDM,972,RC,70492,CPT,,,26,,BOTH,,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT NECK WITH,704910-9,CDM,972,RC,70491,CPT,,,26,,BOTH,,,191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT NECK W/O,704900-0,CDM,972,RC,70490,CPT,,,26,,BOTH,,,176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT FACIAL/SIN COM,704880-4,CDM,972,RC,70488,CPT,,,26,,BOTH,,,196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT FACIAL/SIN WIT,704870-5,CDM,972,RC,70487,CPT,,,26,,BOTH,,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT FACIAL/SIN W/O,704861-4,CDM,972,RC,70486,CPT,,,26,,BOTH,,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,500,500,500,1 through 10,percent of total billed charges,,,,
PF CT ORBIT COMBINED,704820-0,CDM,972,RC,70482,CPT,,,26,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ORBIT WITH,704811-9,CDM,972,RC,70481,CPT,,,26,,BOTH,,,191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT ORBIT W/O,704800-2,CDM,972,RC,70480,CPT,,,26,,BOTH,,,176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT HEAD COMBINED,704700-4,CDM,972,RC,70470,CPT,,,26,,BOTH,,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT HEAD WITH,704600-6,CDM,972,RC,70460,CPT,,,26,,BOTH,,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF CT HEAD W/O,704500-8,CDM,972,RC,70450,CPT,,,26,,BOTH,,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF NECK ST,703600-7,CDM,972,RC,70360,CPT,,,26,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TMJ BI,703300-4,CDM,972,RC,70330,CPT,,,26,,BOTH,,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TMJ'S UNI LT,730017-1,CDM,972,RC,70328,CPT,,,52,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF TMJ'S UNI RT,730016-3,CDM,972,RC,70320,CPT,,,52,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SKULL MIN 4V,702600-8,CDM,972,RC,70260,CPT,,,26,,BOTH,,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SKULL LESS 4V,702500-0,CDM,972,RC,70250,CPT,,,26,,BOTH,,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SINUSES 3V,702200-7,CDM,972,RC,70220,CPT,,,26,,BOTH,,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF SINUJSES 1 OR 2V,702100-9,CDM,972,RC,70210,CPT,,,26,,BOTH,,,17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBITS 4V,702000-1,CDM,972,RC,70200,CPT,,,26,,BOTH,,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBITS LESS 4V LT,730034-6,CDM,972,RC,70190,CPT,,,LT,,BOTH,,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBITS LESS 4V RT,730033-8,CDM,972,RC,70190,CPT,,,RT,,BOTH,,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF NASAL BONES,701600-9,CDM,972,RC,70160,CPT,,,26,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FACIAL BONES 3V,701500-1,CDM,972,RC,70150,CPT,,,26,,BOTH,,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FACIAL BONES 1-2V,701400-4,CDM,972,RC,70140,CPT,,,26,,BOTH,,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MASTIODS LESS 3V,701300-6,CDM,972,RC,70130,CPT,,,26,,BOTH,,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MANDIBLE 4V,701101-8,CDM,972,RC,70110,CPT,,,26,,BOTH,,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MANDIBLE PARTIAL,701001-0,CDM,972,RC,70100,CPT,,,26,,BOTH,,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBIT FB LT,730024-7,CDM,972,RC,70030,CPT,,,LT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBIT FB RT,730023-9,CDM,972,RC,70030,CPT,,,RT,,BOTH,,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ORBIT FB BI,730048-6,CDM,972,RC,70030,CPT,,,50,,BOTH,,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF LUMBAR PUNC W/IMG,730028-8,CDM,972,RC,62328,CPT,,,,,BOTH,,,278.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF MYLOGM INJ LUMBAR,62284-5,CDM,972,RC,62284,CPT,,,26,,BOTH,,,166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ASP THYROID CYST,730103-9,CDM,972,RC,60300,CPT,,,,,BOTH,,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF NEPHROSTOMY EXCH,730182-3,CDM,972,RC,50435,CPT,,,,,BOTH,,,237,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RENAL CYST ASP,730119-5,CDM,972,RC,50390,CPT,,,26,,BOTH,,,226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF EVAL GTUBE W/CONT,730158-3,CDM,972,RC,49465,CPT,,,,,BOTH,,,72.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RPLCE GJ TUBE W/F,730186-4,CDM,972,RC,49452,CPT,,,,,BOTH,,,326.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF RPLCE GTUBE W/FLO,730157-5,CDM,972,RC,49450,CPT,,,,,BOTH,,,326.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF PARACENTESIS W/IM,76841-6,CDM,972,RC,49083,CPT,,,,,BOTH,,,129.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF LIVER BX,47000-5,CDM,972,RC,47000,CPT,,,26,,BOTH,,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF PICC DECLOT,730138-5,CDM,972,RC,36596,CPT,,,,,BOTH,,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF DIALYSIS CATH REM,730153-4,CDM,972,RC,36589,CPT,,,,,BOTH,,,331.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF PICC REPLACEMENT,730152-6,CDM,972,RC,36584,CPT,,,,,BOTH,,,157.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF DLYSIS CATH RPLMT,730155-9,CDM,972,RC,36581,CPT,,,26,,BOTH,,,471.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF PICC INSERTION,704901-8,CDM,972,RC,36573,CPT,,,,,BOTH,,,368,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF THOROCENTSIS W/IM,730102-1,CDM,972,RC,32555,CPT,,,,,BOTH,,,239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF INJ ARTHO SHOLDER,233500-8,CDM,972,RC,23350,CPT,,,26,,BOTH,,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF JNT IJ/AP W/U/S G,76889-5,CDM,972,RC,20611,CPT,,,26,,BOTH,,,150.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BREAST BX ADD LES,76887-9,CDM,972,RC,19084,CPT,,,,,BOTH,,,183.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BREAST BX W/IMAG,76890-3,CDM,972,RC,19083,CPT,,,26,,BOTH,,,393.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BREAST ASP AD CYS,76888-7,CDM,972,RC,19001,CPT,,,,,BOTH,,,50.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF BREAST ASP,19000-9,CDM,972,RC,19000,CPT,,,,,BOTH,,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF ASPIRATION ABSCES,730185-6,CDM,972,RC,10160,CPT,,,26,,BOTH,,,226.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PF FI NEED ASP W/IM,100221-1,CDM,972,RC,10005,CPT,,,,,BOTH,,,238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WOUND CLOSE ADHESIVE,16810-4,CDM,981,RC,G0168,HCPCS,,,,,BOTH,,,203.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRITICIAL C ADD 30 M,293652-4,CDM,981,RC,99292,CPT,,,,,BOTH,,,272.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CRITICAL CARE 1ST HR,992911-8,CDM,981,RC,99291,CPT,,,,,BOTH,,,377,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTENSIVE EXAM,20222-6,CDM,981,RC,99285,CPT,,,,,BOTH,,,410.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXTENDED EXAM,992841-7,CDM,981,RC,99284,CPT,,,,,BOTH,,,292.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,400,146,100300,25,percent of total billed charges,,,,
INTERMEDIATE EXAM,992831-8,CDM,981,RC,99283,CPT,,,,,BOTH,,,196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,275,270.2,22055,46,percent of total billed charges,,,,
LIMITED EXAM,992821-9,CDM,981,RC,99282,CPT,,,,,BOTH,,,140,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BRIEF EXAM,992811-0,CDM,981,RC,99281,CPT,,,,,BOTH,,,50.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OSTEOPATHIC MANIPUAL,293654-0,CDM,981,RC,98925,CPT,,,,,BOTH,,,58.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EKG PHYSICIAN FEE,9133471-4,CDM,981,RC,93010,CPT,,,,,BOTH,,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CARDIOVERSION,495935-9,CDM,981,RC,92960,CPT,,,,,BOTH,,,571.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CPR,929501-5,CDM,981,RC,92950,CPT,,,,,BOTH,,,670.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM IMPACTED CERUMEN,692101-9,CDM,981,RC,69210,CPT,,,,,BOTH,,,77.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB AUDIT CANAL,692001-1,CDM,981,RC,69200,CPT,,,,,BOTH,,,287.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN EXT EAR ABSCES,690001-3,CDM,981,RC,69000,CPT,,,,,BOTH,,,280.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB EYELID,679381-4,CDM,981,RC,67938,CPT,,,,,BOTH,,,541.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUT REC WOUND LID FT,679351-7,CDM,981,RC,67935,CPT,,,,,BOTH,,,1370.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUT REC WOUND LID PT,679301-2,CDM,981,RC,67930,CPT,,,,,BOTH,,,839.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB CORNEAL/LAMP,652221-3,CDM,981,RC,65222,CPT,,,,,BOTH,,,136.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB EYE CORNEAL,652201-5,CDM,981,RC,65220,CPT,,,,,BOTH,,,98.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB EYE CONJUNC,652101-7,CDM,981,RC,65210,CPT,,,,,BOTH,,,124.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB EYE SUPERFIC,625051-8,CDM,981,RC,65205,CPT,,,,,BOTH,,,101.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NERVE BLOCK,255002-8,CDM,981,RC,64450,CPT,,,,,BOTH,,,110.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LUMBAR PUNCTURE,9133455-7,CDM,981,RC,62270,CPT,,,,,BOTH,,,187.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DELIVERED PLACENTA,594141-4,CDM,981,RC,59414,CPT,,,,,BOTH,,,198.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VAGINAL DELIVERY,594091-1,CDM,981,RC,59409,CPT,,,,,BOTH,,,1746.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
I&D BARTHOLIN'S ABSC,564201-2,CDM,981,RC,56420,CPT,,,,,BOTH,,,245,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INC & DRNG VUL/PERI,366802-7,CDM,981,RC,56405,CPT,,,,,BOTH,,,207.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHNG CYSTOSTOMY TUBE,277863-7,CDM,981,RC,51705,CPT,,,,,BOTH,,,128.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
F/C ANCHORED,517020-4,CDM,981,RC,51702,CPT,,,,,BOTH,,,115.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INCISION HEMORRHOID,460831-1,CDM,981,RC,46083,CPT,,,,,BOTH,,,399.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
I&D PERIANAL ABSCESS,460501-0,CDM,981,RC,46050,CPT,,,,,BOTH,,,431.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB PHARYNX,428091-3,CDM,981,RC,42809,CPT,,,,,BOTH,,,404.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN OF ABS CYS HEM,284002-3,CDM,981,RC,41800,CPT,,,,,BOTH,,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LAC TONGUE >2.6C,412521-7,CDM,981,RC,41252,CPT,,,,,BOTH,,,730,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP POST TONGUE 2.5,412511-8,CDM,981,RC,41251,CPT,,,,,BOTH,,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP ANT TONGUE 2.5/L,412501-9,CDM,981,RC,41250,CPT,,,,,BOTH,,,560.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LIP HALF VERTICA,406541-3,CDM,981,RC,40654,CPT,,,,,BOTH,,,1337.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LIP TO H VERTICA,406521-5,CDM,981,RC,40652,CPT,,,,,BOTH,,,1135.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LIP FULL THICK,406501-7,CDM,981,RC,40650,CPT,,,,,BOTH,,,974.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLCMT NDLE INTRO INF,366801-9,CDM,981,RC,36680,CPT,,,,,BOTH,,,144.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLCMT CENT VENOUS CATH; PERQ > 2YR,364891-2,CDM,981,RC,36556,CPT,,,,,BOTH,,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PLCMT CENT VENOUS CATH; PERQ <2 YR,364881-3,CDM,981,RC,36488,CPT,,,,,BOTH,,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENIPUNCT CUTDOWN >1,364251-9,CDM,981,RC,36425,CPT,,,,,BOTH,,,95.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
VENIPUNCT CUTDOWN <1,364201-4,CDM,981,RC,36420,CPT,,,,,BOTH,,,114.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHEST TUBE W/W SEAL,131602-5,CDM,981,RC,32551,CPT,,,,,BOTH,,,416,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CHEST TUBE,131603-3,CDM,981,RC,32550,CPT,,,,,BOTH,,,530,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRANSTRACH INT TUBE,317301-0,CDM,981,RC,31730,CPT,,,,,BOTH,,,357.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRACH EMER PROC,316051-2,CDM,981,RC,31605,CPT,,,,,BOTH,,,440.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRACHEOSTOMY EMER PR,316031-4,CDM,981,RC,31603,CPT,,,,,BOTH,,,540,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TRACH TUBE REPLACEME,31502-8,CDM,981,RC,31502,CPT,,,,,BOTH,,,84.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTUBATION,315001-8,CDM,981,RC,31500,CPT,,,,,BOTH,,,263.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL PACK POST/SUBS,309061-0,CDM,981,RC,30906,CPT,,,,,BOTH,,,649.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL PACK POST,309051-1,CDM,981,RC,30905,CPT,,,,,BOTH,,,572.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NASAL PACK/SIM HEM,309011-5,CDM,981,RC,30901,CPT,,,,,BOTH,,,226.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REMOVAL FB NARE,303001-2,CDM,981,RC,30300,CPT,,,,,BOTH,,,234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APP SHORT LEG SPLINT,295151-5,CDM,981,RC,29515,CPT,,,,,BOTH,,,114.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APP LONG LEG SPLINT,295051-7,CDM,981,RC,29505,CPT,,,,,BOTH,,,192.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APP FINGER SPLINT,291301-0,CDM,981,RC,29130,CPT,,,,,BOTH,,,66.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APP SHORT ARM SPLINT,291251-7,CDM,981,RC,29125,CPT,,,,,BOTH,,,89.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
APP LONG ARM SPLINT,291051-1,CDM,981,RC,29105,CPT,,,,,BOTH,,,137.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO IP JT DIS WO ANE,286601-0,CDM,981,RC,28660,CPT,,,,,BOTH,,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REDUCTION TOE,286301-7,CDM,981,RC,28630,CPT,,,,,BOTH,,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FOREIGN BDY FOOT,120074-0,CDM,981,RC,28190,CPT,,,,,BOTH,,,312.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB FOOT,281901-9,CDM,981,RC,28190,CPT,,,,,BOTH,,,318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX ANK DIS WO AN,278401-5,CDM,981,RC,27840,CPT,,,,,BOTH,,,888.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP EXT TENDON LEG,131532-4,CDM,981,RC,27664,CPT,,,,,BOTH,,,870.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX PATEL D WO AN,275601-3,CDM,981,RC,27560,CPT,,,,,BOTH,,,817.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX IP JT DIS W/M,267701-1,CDM,981,RC,26770,CPT,,,,,BOTH,,,210,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX DIST PHALANGE,267551-0,CDM,981,RC,26755,CPT,,,,,BOTH,,,208.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REDUCTION DISC FINGER,992732-8,CDM,981,RC,26700,CPT,,,,,BOTH,,,653.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN FINGER ABSCESS,260101-1,CDM,981,RC,26010,CPT,,,,,BOTH,,,311.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX DIST RAD FX,256051-4,CDM,981,RC,25605,CPT,,,,,BOTH,,,1216.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB FOREARM/WRIST,252481-7,CDM,981,RC,25248,CPT,,,,,BOTH,,,994.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX RADIAL HEAD SUBLUXA CHILD,246401-4,CDM,981,RC,24640,CPT,,,,,BOTH,,,221,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO ELBOW DIS W/ANES,120442-9,CDM,981,RC,24605,CPT,,,,,BOTH,,,1137.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB UPPER ARM,242001-6,CDM,981,RC,24200,CPT,,,,,BOTH,,,462.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TREAT SHOULDER DISCL,940026-8,CDM,981,RC,23655,CPT,,,,,BOTH,,,897.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TX SHLDR DIS W/M,236501-3,CDM,981,RC,23650,CPT,,,,,BOTH,,,496,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CLO TR  TEMPOROMAND,284902-4,CDM,981,RC,21480,CPT,,,,,BOTH,,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTHROCENT/ASPIR/INJ,206101-8,CDM,981,RC,20610,CPT,,,,,BOTH,,,111.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTHROCENT/ASPIR/INJ,206051-5,CDM,981,RC,20605,CPT,,,,,BOTH,,,92.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
ARTHROCENTESIS/ASPIR/INJ;SM JT,206001-0,CDM,981,RC,20600,CPT,,,,,BOTH,,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INJ THER CARPAL TUN,131533-2,CDM,981,RC,20526,CPT,,,,,BOTH,,,140.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB MUSCLE/TENDON,250201-1,CDM,981,RC,20520,CPT,,,,,BOTH,,,450.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXPL PEN ABD/FL/BACK,120076-5,CDM,981,RC,20102,CPT,,,,,BOTH,,,583,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXPL PEN WOUND NECK,120075-7,CDM,981,RC,20100,CPT,,,,,BOTH,,,1401.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BURN DEBRIDEMENT,160301-8,CDM,981,RC,16030,CPT,,,,,BOTH,,,309.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INT TX 1ST DEG BURN,160001-4,CDM,981,RC,16000,CPT,,,,,BOTH,,,159.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP EYE/NOSE/EAR A 5,131531-6,CDM,981,RC,13153,CPT,,,,,BOTH,,,341.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LID/LIP 2.6-7.5C,131521-7,CDM,981,RC,13152,CPT,,,,,BOTH,,,1015.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LID/LIP 1.1-2.5C,131511-8,CDM,981,RC,13151,CPT,,,,,BOTH,,,756.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP LID/LIP 1.0-LESS,131501-9,CDM,981,RC,13150,CPT,,,,,BOTH,,,650.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP FAC/HND/FT AD 5C,131331-1,CDM,981,RC,13133,CPT,,,,,BOTH,,,317.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP FOREHEAD 2.6-7.5,131321-2,CDM,981,RC,13132,CPT,,,,,BOTH,,,1119.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP FOREHEAD 1.1-2.5,131311-3,CDM,981,RC,13131,CPT,,,,,BOTH,,,655.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP SCLP/ARM/LEG A 5,131221-4,CDM,981,RC,13122,CPT,,,,,BOTH,,,205.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP SCLP/EXT 2.6-7.5,131211-5,CDM,981,RC,13121,CPT,,,,,BOTH,,,776.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP SCLP/EXT 1.1-2.5,131201-6,CDM,981,RC,13120,CPT,,,,,BOTH,,,581.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP TRUNK A 5CM/LESS,131021-8,CDM,981,RC,13102,CPT,,,,,BOTH,,,179.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP TRUNK 2.6-7.5 CM,131011-9,CDM,981,RC,13101,CPT,,,,,BOTH,,,676.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP TRUNK 1.1-2.5 CM,131001-0,CDM,981,RC,13100,CPT,,,,,BOTH,,,554.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE OVER 30.0CM,120571-5,CDM,981,RC,12057,CPT,,,,,BOTH,,,902.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE 20.1-3.0CM,120561-6,CDM,981,RC,12056,CPT,,,,,BOTH,,,814.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE 12.6-20.0CM,120551-7,CDM,981,RC,12055,CPT,,,,,BOTH,,,644.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE 7.6-12.5 CM,120541-8,CDM,981,RC,12054,CPT,,,,,BOTH,,,537.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE 5.1-7.5 CM,120531-9,CDM,981,RC,12053,CPT,,,,,BOTH,,,511.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE 2.5-5.0 CM,120521-0,CDM,981,RC,12052,CPT,,,,,BOTH,,,514.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/FACE LESS 2.5 CM,120511-1,CDM,981,RC,12051,CPT,,,,,BOTH,,,430.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK OVER 30.0CM,120471-8,CDM,981,RC,12047,CPT,,,,,BOTH,,,727.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK 20.1-30.0CM,120461-9,CDM,981,RC,12046,CPT,,,,,BOTH,,,674.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK 12.6-20.0CM,120451-0,CDM,981,RC,12045,CPT,,,,,BOTH,,,720.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK 7.6-12.5 CM,120441-1,CDM,981,RC,12044,CPT,,,,,BOTH,,,500.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK 2.6-7.5 CM,120421-3,CDM,981,RC,12042,CPT,,,,,BOTH,,,471.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/NECK LESS 2.5 CM,120411-4,CDM,981,RC,12041,CPT,,,,,BOTH,,,404.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY OVER 30.0CM,120371-0,CDM,981,RC,12037,CPT,,,,,BOTH,,,736.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY 20.1-30.0CM,120361-1,CDM,981,RC,12036,CPT,,,,,BOTH,,,635.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY 12.6-20.0CM,120351-2,CDM,981,RC,12035,CPT,,,,,BOTH,,,555.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY 7.6-12.5 CM,120341-3,CDM,981,RC,12034,CPT,,,,,BOTH,,,480.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY 2.6-7.5 CM,120321-5,CDM,981,RC,12032,CPT,,,,,BOTH,,,460.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LAY/BODY LESS-2.5 CM,120311-6,CDM,981,RC,12031,CPT,,,,,BOTH,,,381.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE OVER 30,120181-3,CDM,981,RC,12018,CPT,,,,,BOTH,,,445.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE 20.1-30,120171-4,CDM,981,RC,12017,CPT,,,,,BOTH,,,384.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE 12.6-20,120161-5,CDM,981,RC,12016,CPT,,,,,BOTH,,,334.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM R FACE 7.6-12.5,120151-6,CDM,981,RC,12015,CPT,,,,,BOTH,,,248.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE 5.1-7.5,120141-7,CDM,981,RC,12014,CPT,,,,,BOTH,,,201.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE 2.6-5.0,120131-8,CDM,981,RC,12013,CPT,,,,,BOTH,,,160.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP FACE 2.5-LES,120111-0,CDM,981,RC,12011,CPT,,,,,BOTH,,,142.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUT/FACE UP TO 2.5CM,120073-2,CDM,981,RC,12011,CPT,,,,,BOTH,,,142.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP SCLP/TRK >30,120071-6,CDM,981,RC,12007,CPT,,,,,BOTH,,,569.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM R SC/TRK 20.1-30,120061-7,CDM,981,RC,12006,CPT,,,,,BOTH,,,488.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM R SC/TRK 12.6-20,120051-8,CDM,981,RC,12005,CPT,,,,,BOTH,,,249.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM R SC/TRK7.6-12.5,120041-9,CDM,981,RC,12004,CPT,,,,,BOTH,,,186.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM R SC/TRK 2.6-7.5,120021-1,CDM,981,RC,12002,CPT,,,,,BOTH,,,151.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SIM REP SCLP/TRK 2.5,120011-2,CDM,981,RC,12001,CPT,,,,,BOTH,,,116,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM NON-B DRUG IMPL,293653-2,CDM,981,RC,11982,CPT,,,,,BOTH,,,245,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
WEDGE EXC SKIN NAIL,117651-0,CDM,981,RC,11765,CPT,,,,,BOTH,,,160.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REP NAIL BED,117601-5,CDM,981,RC,11760,CPT,,,,,BOTH,,,307.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EXC OF NAIL,117501-7,CDM,981,RC,11750,CPT,,,,,BOTH,,,407.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
EVACUATION SUBUNGUAL HEMATOMA,117401-0,CDM,981,RC,11740,CPT,,,,,BOTH,,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AVULSION NAIL PLATE,291261-6,CDM,981,RC,11730,CPT,,,,,BOTH,,,122.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEBRIDEMENT SKIN,110421-5,CDM,981,RC,11042,CPT,,,,,BOTH,,,112.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PUNCT ASPIR ABSCESS,101601-3,CDM,981,RC,10160,CPT,,,,,BOTH,,,223.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB SKIN COMPL,101211-1,CDM,981,RC,10121,CPT,,,,,BOTH,,,432.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
REM FB SKIN,101201-2,CDM,981,RC,10120,CPT,,,,,BOTH,,,213.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DRAIN PILONEAL CYST,297302-2,CDM,981,RC,10080,CPT,,,,,BOTH,,,238.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
I&D ABSCESS,100611-3,CDM,981,RC,10061,CPT,,,,,BOTH,,,431,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
I&D ABSCESS SINGLE,100601-4,CDM,981,RC,10060,CPT,,,,,BOTH,,,258.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBSQ NSG FACILITY,3060009-2,CDM,987,RC,99309,CPT,,,,,BOTH,,,214.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBSQ NSG FACILITY,3060008-4,CDM,987,RC,99308,CPT,,,,,BOTH,,,163.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SUBSQ  NSG FACILITY,3060007-6,CDM,987,RC,99307,CPT,,,,,BOTH,,,103.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHOWER CAP,860648-5,CDM,990,RC,,,,,,,BOTH,,,0.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
KOTEX INDIVIDUAL,860639-4,CDM,990,RC,,,,,,,BOTH,,,0.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
AFTER SHAVE LOTION,860653-5,CDM,990,RC,,,,,,,BOTH,,,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
COMB,860619-6,CDM,990,RC,,,,,,,BOTH,,,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
INTENSIVE OUTPT SNCK,96068-2,CDM,990,RC,,,,,,,BOTH,,,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOOTHBRUSH,860616-2,CDM,990,RC,,,,,,,BOTH,,,1.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
LEMON GLYCERIN,860638-6,CDM,990,RC,,,,,,,BOTH,,,1.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
BED PAN,81948-2,CDM,990,RC,,,,,,,BOTH,,,1.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
FX BEDPAN,81947-4,CDM,990,RC,,,,,,,BOTH,,,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CEPACOL,860636-0,CDM,990,RC,,,,,,,BOTH,,,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
TOOTHPASTE,860617-0,CDM,990,RC,,,,,,,BOTH,,,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DEODORANT,860602-2,CDM,990,RC,,,,,,,BOTH,,,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
PHONE CHARGE,860622-0,CDM,990,RC,,,,,,,BOTH,,,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
HAIR BRUSH,860650-1,CDM,990,RC,,,,,,,BOTH,,,3.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"DERMASSAGE, LOTION",860603-0,CDM,990,RC,,,,,,,BOTH,,,4.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POWDER, BABY",860611-3,CDM,990,RC,,,,,,,BOTH,,,4.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHAVE CREAM,860652-7,CDM,990,RC,,,,,,,BOTH,,,4.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
DISP SHORT ARMBOARD,80958-2,CDM,990,RC,,,,,,,BOTH,,,4.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ICE PACKS, DISP",860605-5,CDM,990,RC,,,,,,,BOTH,,,4.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
OUTPATIENT MEALS,860631-1,CDM,990,RC,,,,,,,BOTH,,,7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
GUEST TRAY,860635-2,CDM,990,RC,,,,,,,BOTH,,,7.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"INVALID RINGS, DISP",860607-1,CDM,990,RC,,,,,,,BOTH,,,9.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
NO-RINSE SHAMPOO,860637-8,CDM,990,RC,,,,,,,BOTH,,,10.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"SITZ BATH, DISP",860613-9,CDM,990,RC,,,,,,,BOTH,,,18.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SHAMPOO,860612-1,CDM,990,RC,,,,,,,BOTH,,,20.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
SPECIAL DELIVERY FEE,98000-3,CDM,990,RC,,,,,,,BOTH,,,108.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE ACE 2"",1.30""",80003-7,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE ACE 3"",1.80""",80004-5,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE ACE 4"",1.80""",82008-4,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE ACE 6"",2.85""",80005-2,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE KERLIX 2"",2.53""",82186-8,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE KERLIX 3"",3.55""",82187-6,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE KLING 1"",2.01""",82028-2,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE KLING 3"",2.45""",81976-3,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BANDAGE KLING 4"",2.95""",81977-1,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"BRACE CASH 42"",375.65""",83058-8,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"COBAN 2"",4.25""",82966-3,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"DRESSING BIATAIN 3"",13.50""",82860-8,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"FINGER PROTECTOR 3 1/2"",6.25""",82069-6,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"GORE GRAFT 1"",166.25""",80230-6,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"HALF PIN 3"",113.75""",82453-2,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"HALF PIN 4"",145.25""",82454-0,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"KLING BANDAGE 2"",4.25""",82027-4,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MESH SURGI OVAL 1/2"",612.85""",83148-7,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MICROFOAM TAPE 1"",7.75""",82475-5,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"MICROFOAM TAPE 3"",24.00""",82476-3,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NASAL PACKING SPONGE 1/2X1 1/2"",4.60""",82981-2,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"NEEDLE, SPINAL SPROTTE 24 GA 6"",33.00""",82796-4,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKING IODOFORM 1"",13.75""",82731-1,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKING IODOFORM 2"",13.75""",82156-1,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKING PLAIN 1"",30.50""",82158-7,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKING PLAIN 1/2"",30.50""",82157-9,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"PACKING PLAIN 2"",30.50""",82159-5,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"POUCH, HIGH OUTPUT 4 3/4"",395.00""",87979-1,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ST WEBRIL 4"",6.50""",82472-2,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"ST WEBRIL 6"",9.00""",82473-0,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE ADHESIVE 1"",4.00""",82161-1,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE ADHESIVE 2"",4.00""",82162-9,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE ADHESIVE 3"",4.00""",82163-7,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE HYTAPE PINK 2"",29.84""",83032-3,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE MEDIPORE 6"",27.04""",824771-0,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"TAPE, HYTAPE PINK 1"",15.00""",82980-4,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
"WAFER, SKIN BARRIER/FLANGE 2 1/4"",14.75""",82968-9,CDM,,,,,,,,,BOTH,,,320,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,,,,,,,,,88,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,,
CENTRAL LINE INSERT,99164-6,CDM,360,RC,36556,CPT,,,,,BOTH,,,1383,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
I & D OF ABSCESS,366-5,CDM,360,RC,10060,CPT,,,,,BOTH,,,295,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
ENDOMETRIAL BIOPSY,357-4,CDM,361,RC,58100,CPT,,,,,BOTH,,,197,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
ENDOMETRIAL BIOPSY,192-5,CDM,361,RC,58100,CPT,,,,,BOTH,,,197,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
RENAL BIOPSY,502000-3,CDM,361,RC,50200,CPT,,,,,BOTH,,,300,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
BREAST BX ADD LESION,50211-2,CDM,361,RC,19084,CPT,,,TC,,BOTH,,,1089.45,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
BREAST ASP ADDLESION,50212-0,CDM,361,RC,19001,CPT,,,,,BOTH,,,64.58,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
DEST SEC-14 LESIONS,165-1,CDM,361,RC,17003,CPT,,,,,BOTH,,,150,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
DEST SEC-14 LESIONS,343-4,CDM,361,RC,17003,CPT,,,,,BOTH,,,150,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
DEST FIRST LESION,164-4,CDM,361,RC,17000,CPT,,,,,BOTH,,,168,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
DEST FIRST LESION,342-6,CDM,361,RC,17000,CPT,,,,,BOTH,,,168,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
LAY/BODY LESS-2.5 CM,345-9,CDM,361,RC,12031,CPT,,,,,BOTH,,,421,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
LAY/BODY LESS-2.5 CM,171-9,CDM,361,RC,12031,CPT,,,,,BOTH,,,421,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
EXC BENIGN LESION,148-7,CDM,361,RC,11423,CPT,,,,,BOTH,,,421,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
EXC BENIGN LESION,344-2,CDM,361,RC,11423,CPT,,,,,BOTH,,,421,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
EXC BENIGN LESION,297303-0,CDM,361,RC,11420,CPT,,,,,BOTH,,,221,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
REMOVAL SKIN TAG,168-5,CDM,361,RC,11200,CPT,,,,,BOTH,,,181,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
REMOVAL SKIN TAG,361-6,CDM,361,RC,11200,CPT,,,,,BOTH,,,181,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
BIOPSY SKIN S LESION,153-7,CDM,361,RC,11100,CPT,,,,,BOTH,,,210,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
BIOPSY SKIN S LESION,347-5,CDM,361,RC,11100,CPT,,,,,BOTH,,,210,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
I & D OF ABSCESS,143-8,CDM,361,RC,10060,CPT,,,,,BOTH,,,295,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,1138,,,,,,,Case Rate,,,20,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1168,,,,,,,Case Rate,,1138,1168,
PRIVATE ROOM-MSB,44013-1,CDM,120,RC,,,,,,,INPATIENT,,,1246,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,22,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1050,,,,,,,Per Diem,,1050,1050,
SEMI PRIVATE ROOM,44010-7,CDM,120,RC,,,,,,,INPATIENT,,,1246,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,22,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1050,,,,,,,Per Diem,,1050,1050,
PRIVATE ROOM-MAC,44012-3,CDM,120,RC,,,,,,,INPATIENT,,,1436,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,22,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1050,,,,,,,Per Diem,,1050,1050,
SEMI PRIVATE ROOM,44002-4,CDM,120,RC,,,,,,,INPATIENT,,,1436,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,22,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,1050,,,,,,,Per Diem,,1050,1050,
OBSERVATION F OFFICE,2003-2,CDM,762,RC,G0379,HCPCS,,,,,BOTH,,,39.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,600,,,,,,,Per Diem,,600,600,
OBSERVATION ADD HOUR,2000-8,CDM,762,RC,G0378,HCPCS,,,,,BOTH,,,39.17,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,600,,,,,,,Per Diem,,600,600,
CT GUID NEEDLE PLACE,50220-3,CDM,350,RC,77012,CPT,,,,,BOTH,,,100,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA ABDOMEN AORTA,50321-9,CDM,350,RC,75635,CPT,,,,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL COM IV NO,52197-1,CDM,350,RC,74178,CPT,,,,,BOTH,,,835.6,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL COM IV OC,50241-9,CDM,350,RC,74178,CPT,,,50,,BOTH,,,835.6,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,73,,515,212,1251.06,29,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL W IV NO,52196-3,CDM,350,RC,74177,CPT,,,,,BOTH,,,749.52,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL W IV OC,50240-1,CDM,350,RC,74177,CPT,,,50,,BOTH,,,749.52,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL W/O IV OC,50239-3,CDM,350,RC,74177,CPT,,,50,,BOTH,,,749.52,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,73,,515,257,1032,40,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL RENAL,50242-7,CDM,350,RC,74176,CPT,,,50,,BOTH,,,484.62,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD/PEL W/O IV NO,52195-5,CDM,350,RC,74176,CPT,,,,,BOTH,,,484.62,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,73,,387,177.9,484,91,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA ABDOMEN,50320-1,CDM,350,RC,74175,CPT,,,,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA ABDOMEN/PELVIS,50335-9,CDM,350,RC,74174,CPT,,,,,BOTH,,,664.86,,,73,,427,356.6,497.4,1 through 10,percent of total billed charges,,,73,,427,356.6,497.4,1 through 10,percent of total billed charges,,,73,,427,356.6,497.4,1 through 10,percent of total billed charges,,,73,,427,356.6,497.4,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD COMB IV NO,50219-5,CDM,350,RC,74170,CPT,,,,,BOTH,,,1584,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD COMB OC,50235-1,CDM,350,RC,74170,CPT,,,50,,BOTH,,,1584,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,73,,462,462,462,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD W IV NO,50218-7,CDM,350,RC,74160,CPT,,,,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD W IV OC,50234-4,CDM,350,RC,74160,CPT,,,50,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD W/O IV OC,50233-6,CDM,350,RC,74160,CPT,,,50,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ABD W/O IV NO,50217-9,CDM,350,RC,74150,CPT,,,,,BOTH,,,1260,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA LOWER EXT LT,50327-6,CDM,350,RC,73706,CPT,,,LT,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA LOWER EXT RT,50326-8,CDM,350,RC,73706,CPT,,,RT,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA LOWER EXT BIL,50328-4,CDM,350,RC,73706,CPT,,,50,,BOTH,,,1692.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER E W&W/O C L,50224-5,CDM,350,RC,73702,CPT,,,LT,,BOTH,,,1774,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER E W&W/O C R,52093-2,CDM,350,RC,73702,CPT,,,RT,,BOTH,,,1774,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER E W&W/O C B,50225-2,CDM,350,RC,73702,CPT,,,50,,BOTH,,,3558,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/CON LT,50226-0,CDM,350,RC,73701,CPT,,,LT,,BOTH,,,1602,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/CON RT,52102-1,CDM,350,RC,73701,CPT,,,RT,,BOTH,,,1602,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/CON BI,50227-8,CDM,350,RC,73701,CPT,,,50,,BOTH,,,3204,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/O C LT,50221-1,CDM,350,RC,73700,CPT,,,LT,,BOTH,,,1315,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/O C RT,73700-7,CDM,350,RC,73700,CPT,,,RT,,BOTH,,,1315,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT LOWER EX W/O C BI,50222-9,CDM,350,RC,73700,CPT,,,50,,BOTH,,,2630,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA UPPER EXT LT,50324-3,CDM,350,RC,73206,CPT,,,LT,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA UPPER EXT RT,50323-5,CDM,350,RC,73206,CPT,,,RT,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA UPPER EXT BIL,50325-0,CDM,350,RC,73206,CPT,,,50,,BOTH,,,1692.36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER E W&W/O C L,50228-6,CDM,350,RC,73202,CPT,,,LT,,BOTH,,,1672,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER E W&W/O C R,52095-7,CDM,350,RC,73202,CPT,,,RT,,BOTH,,,1672,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER E W&W/O C B,50229-4,CDM,350,RC,73202,CPT,,,50,,BOTH,,,3344,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/CON LT,50230-2,CDM,350,RC,73201,CPT,,,LT,,BOTH,,,1464,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/CON RT,52094-0,CDM,350,RC,73201,CPT,,,RT,,BOTH,,,1464,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/CON BI,50231-0,CDM,350,RC,73201,CPT,,,50,,BOTH,,,2928,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/O C LT,50232-8,CDM,350,RC,73200,CPT,,,LT,,BOTH,,,1258,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/O C RT,50311-0,CDM,350,RC,73200,CPT,,,RT,,BOTH,,,1258,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT UPPER EX W/O C BI,50223-7,CDM,350,RC,73200,CPT,,,50,,BOTH,,,2326,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS COMB IV OC,50238-5,CDM,350,RC,72194,CPT,,,50,,BOTH,,,749.52,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS COMB IV NO,52018-9,CDM,350,RC,72194,CPT,,,,,BOTH,,,1584,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS W IV NO,52017-1,CDM,350,RC,72193,CPT,,,,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS W IV OC,50237-7,CDM,350,RC,72193,CPT,,,50,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS WO IV OC,50236-9,CDM,350,RC,72193,CPT,,,50,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT PELVIS W/O IV NO,52016-3,CDM,350,RC,72192,CPT,,,,,BOTH,,,1260,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA PELVIS,50322-7,CDM,350,RC,72191,CPT,,,,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT L-SPINE W&W/O CON,52104-7,CDM,350,RC,72133,CPT,,,,,BOTH,,,1235,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT L-SPINE W/CONT,5075-7,CDM,350,RC,72132,CPT,,,,,BOTH,,,1241,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT L-SPINE W/O CONTRAST,50315-1,CDM,350,RC,72131,CPT,,,,,BOTH,,,1404,,,73,,515,264.8,1001.6,15,percent of total billed charges,,,73,,515,264.8,1001.6,15,percent of total billed charges,,,73,,515,264.8,1001.6,15,percent of total billed charges,,,73,,515,264.8,1001.6,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT T-SPINE W/WO,50338-3,CDM,350,RC,72130,CPT,,,,,BOTH,,,459,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT T-SPINE,50314-4,CDM,350,RC,72128,CPT,,,,,BOTH,,,1404,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT C-SPINE W/CONT,52224-3,CDM,350,RC,72126,CPT,,,TC,,BOTH,,,297.25,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT C-SPINE,50313-6,CDM,350,RC,72125,CPT,,,,,BOTH,,,1404,,,73,,321,180,572.45,11,percent of total billed charges,,,73,,321,180,572.45,11,percent of total billed charges,,,73,,321,180,572.45,11,percent of total billed charges,,,73,,321,180,572.45,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA CHEST,50319-3,CDM,350,RC,71275,CPT,,,,,BOTH,,,846.18,,,73,,360,85.4,1517.56,17,percent of total billed charges,,,73,,360,85.4,1517.56,17,percent of total billed charges,,,73,,360,85.4,1517.56,17,percent of total billed charges,,,73,,360,85.4,1517.56,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT CHEST LOW DOSE,52237-5,CDM,350,RC,71271,CPT,,,,,BOTH,,,414.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT CHEST W&W/O CONT,52103-9,CDM,350,RC,71270,CPT,,,,,BOTH,,,1548,,,73,,360,360,360,1 through 10,percent of total billed charges,,,73,,360,360,360,1 through 10,percent of total billed charges,,,73,,360,360,360,1 through 10,percent of total billed charges,,,73,,360,360,360,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT CHEST W/CONTRAST,52037-9,CDM,350,RC,71260,CPT,,,,,BOTH,,,1404,,,73,,959.5,386,2385.08,1 through 10,percent of total billed charges,,,73,,959.5,386,2385.08,1 through 10,percent of total billed charges,,,73,,959.5,386,2385.08,1 through 10,percent of total billed charges,,,73,,959.5,386,2385.08,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT CHEST W/O CONT,50316-9,CDM,350,RC,71250,CPT,,,,,BOTH,,,1260,,,73,,515,150,1768.17,30,percent of total billed charges,,,73,,515,150,1768.17,30,percent of total billed charges,,,73,,515,150,1768.17,30,percent of total billed charges,,,73,,515,150,1768.17,30,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA NECK,50318-5,CDM,350,RC,70498,CPT,,,,,BOTH,,,846.18,,,73,,846,190.4,3759.01,1 through 10,percent of total billed charges,,,73,,846,190.4,3759.01,1 through 10,percent of total billed charges,,,73,,846,190.4,3759.01,1 through 10,percent of total billed charges,,,73,,846,190.4,3759.01,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA BRAIN,50334-2,CDM,350,RC,70496,CPT,,,TC,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CTA HEAD,50317-7,CDM,350,RC,70496,CPT,,,,,BOTH,,,846.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT NECK W&W/O CONT,52040-3,CDM,350,RC,70492,CPT,,,,,BOTH,,,1584,,,73,,169,169,169,1 through 10,percent of total billed charges,,,73,,169,169,169,1 through 10,percent of total billed charges,,,73,,169,169,169,1 through 10,percent of total billed charges,,,73,,169,169,169,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT NECK W/CONTRAST,52030-4,CDM,350,RC,70491,CPT,,,,,BOTH,,,1404,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT NECK W/O CONTRAST,52039-5,CDM,350,RC,70490,CPT,,,,,BOTH,,,1260,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,73,,515,515,515,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT FACIAL/SINUS W/WO,52092-4,CDM,350,RC,70488,CPT,,,,,BOTH,,,1440,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT FACIAL/SINUS W/CO,52091-6,CDM,350,RC,70487,CPT,,,,,BOTH,,,1260,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT FACIAL/SINUS W/O,52050-2,CDM,350,RC,70486,CPT,,,,,BOTH,,,1044,,,73,,515,164,1617.23,13,percent of total billed charges,,,73,,515,164,1617.23,13,percent of total billed charges,,,73,,515,164,1617.23,13,percent of total billed charges,,,73,,515,164,1617.23,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ORBITS W & W/O CONTRAST,52035-3,CDM,350,RC,70482,CPT,,,,,BOTH,,,1367,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ORBITS W/CONTRAST,52036-1,CDM,350,RC,70481,CPT,,,,,BOTH,,,1116,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT ORBITS W/O CONTR,52033-8,CDM,350,RC,70480,CPT,,,,,BOTH,,,845,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT HEAD W-W/O CONT,50216-1,CDM,350,RC,70470,CPT,,,,,BOTH,,,1440,,,73,,515,450.5,977.5,1 through 10,percent of total billed charges,,,73,,515,450.5,977.5,1 through 10,percent of total billed charges,,,73,,515,450.5,977.5,1 through 10,percent of total billed charges,,,73,,515,450.5,977.5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT HEAD W CONT,50215-3,CDM,350,RC,70460,CPT,,,,,BOTH,,,1260,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CT HEAD W/O CONT,50214-6,CDM,350,RC,70450,CPT,,,,,BOTH,,,1044,,,73,,515,327,811.09,51,percent of total billed charges,,,73,,515,327,811.09,51,percent of total billed charges,,,73,,515,327,811.09,51,percent of total billed charges,,,73,,515,327,811.09,51,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
CRITICAL C INT 30-74,20114-5,CDM,450,RC,99291,CPT,,,,,BOTH,,,544.38,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,500,,,,,,,Case Rate,,500,500,
EMERG. ROOM-LEVEL 5,20219-2,CDM,450,RC,99285,CPT,,,,,BOTH,,,425,,994,,,,,,,Case Rate,,994,,,,,,,Case Rate,,994,,,,,,,Case Rate,,994,,,,,,,Case Rate,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,400,,,,,,,Case Rate,,400,994,
EMERG. ROOM-LEVEL 4,20217-6,CDM,450,RC,99284,CPT,,,,,BOTH,,,269,,950,,,,,,,Case Rate,,950,,,,,,,Case Rate,,950,,,,,,,Case Rate,,950,,,,,,,Case Rate,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,400,,,,,,,Case Rate,,400,950,
U/S GUID NDLE PLACE,52077-5,CDM,402,RC,76942,CPT,,,TC,,BOTH,,,432,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S GUID PICC/CL INS,99151-3,CDM,402,RC,76937,CPT,,,,,BOTH,,,91,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXT/AXIL LIM LT,50207-0,CDM,402,RC,76882,CPT,,,LT,,BOTH,,,68,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXT/AXIL LIM RT,50201-3,CDM,402,RC,76882,CPT,,,RT,,BOTH,,,68,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXTREMITY ST LIM,5254-8,CDM,402,RC,76882,CPT,,,,,BOTH,,,68,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXT/AXIL LIM BI,50208-8,CDM,402,RC,76882,CPT,,,50,,BOTH,,,136,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,73,,49,49,49,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXTREMITY LT,99075-4,CDM,402,RC,76881,CPT,,,LT,,BOTH,,,446,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXTREMITY RT,52026-2,CDM,402,RC,76881,CPT,,,RT,,BOTH,,,446,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S EXTREMITIES BI,99167-9,CDM,402,RC,76881,CPT,,,50,,BOTH,,,892,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S SCROTUM,52022-1,CDM,402,RC,76870,CPT,,,,,BOTH,,,532,,,73,,349,127.6,376,1 through 10,percent of total billed charges,,,73,,349,127.6,376,1 through 10,percent of total billed charges,,,73,,349,127.6,376,1 through 10,percent of total billed charges,,,73,,349,127.6,376,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S PELVIC LIMITED,52106-2,CDM,402,RC,76857,CPT,,,,,BOTH,,,500,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S PELVIC/TRANSAB,50209-6,CDM,402,RC,76856,CPT,,,,,BOTH,,,532,,,73,,194,135,310,32,percent of total billed charges,,,73,,194,135,310,32,percent of total billed charges,,,73,,194,135,310,32,percent of total billed charges,,,73,,194,135,310,32,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
"U/S PELVIC, TRANSVAGINAL",52045-2,CDM,402,RC,76830,CPT,,,,,BOTH,,,612,,,73,,446,330,446,26,percent of total billed charges,,,73,,446,330,446,26,percent of total billed charges,,,73,,446,330,446,26,percent of total billed charges,,,73,,446,330,446,26,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S AORTA ABD,52020-5,CDM,402,RC,76770,CPT,,,,,BOTH,,,532,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S RENAL,50204-7,CDM,402,RC,76770,CPT,,,,,BOTH,,,532,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,73,,388,306.2,388,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
AAA SCREEN,50332-6,CDM,402,RC,76706,CPT,,,,,BOTH,,,182.98,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S GALLBLADDER,50203-9,CDM,402,RC,76705,CPT,,,,,BOTH,,,612,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S LIMITED ABDOMINA,52090-8,CDM,402,RC,76705,CPT,,,,,BOTH,,,612,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,73,,446,343.8,446,35,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S ABDOMEN,52061-9,CDM,402,RC,76700,CPT,,,,,BOTH,,,1066,,,73,,778,434,778,13,percent of total billed charges,,,73,,778,434,778,13,percent of total billed charges,,,73,,778,434,778,13,percent of total billed charges,,,73,,778,434,778,13,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST U LIMIT L,52221-9,CDM,402,RC,76642,CPT,,,LT,,BOTH,,,200,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST U LIMIT R,52220-1,CDM,402,RC,76642,CPT,,,RT,,BOTH,,,200,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST U LIMIT B,52222-7,CDM,402,RC,76642,CPT,,,50,,BOTH,,,400,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST LT,52184-9,CDM,402,RC,76641,CPT,,,LT,,BOTH,,,200,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST RT,52185-6,CDM,402,RC,76641,CPT,,,RT,,BOTH,,,200,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S BREAST BI,52183-1,CDM,402,RC,76641,CPT,,,50,,BOTH,,,400,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,73,,146,128,175.2,21,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S CHEST,76836-6,CDM,402,RC,76604,CPT,,,,,BOTH,,,434,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
U/S THYROID/NECK,50200-5,CDM,402,RC,76536,CPT,,,,,BOTH,,,532,,,73,,388,310,388,38,percent of total billed charges,,,73,,388,310,388,38,percent of total billed charges,,,73,,388,310,388,38,percent of total billed charges,,,73,,388,310,388,38,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
ASPIRATION ABSCES,5233-2,CDM,402,RC,10160,CPT,,,,,BOTH,,,932.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,350,,,,,,,Case Rate,,350,350,
EMERG. ROOM-LEVEL 3,20103-8,CDM,450,RC,99283,CPT,,,,,BOTH,,,239,,607,,,,,,,Case Rate,,607,,,,,,,Case Rate,,607,,,,,,,Case Rate,,607,,,,,,,Case Rate,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,275,,,,,,,Case Rate,,275,607,
EEG,60034-6,CDM,740,RC,95816,CPT,,,,,BOTH,,,425.18,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,237,,,,,,,Case Rate,,237,237,
HOLTER APP>7 DAYS,90319-5,CDM,731,RC,93246,CPT,,,,,BOTH,,,31.55,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,189,,,,,,,Case Rate,,189,189,
HOLTER APP>48 HRS,90317-9,CDM,731,RC,93242,CPT,,,,,BOTH,,,31.55,,,73,,23,16.8,23,18,percent of total billed charges,,,73,,23,16.8,23,18,percent of total billed charges,,,73,,23,16.8,23,18,percent of total billed charges,,,73,,23,16.8,23,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,189,,,,,,,Case Rate,,189,189,
BONE DENSITY,52069-2,CDM,320,RC,77078,CPT,,,,,BOTH,,,250,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
BONE SURVEY-INFANT,52012-2,CDM,320,RC,77076,CPT,,,,,BOTH,,,160.68,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
BONE SURVEY>1 YR OLD,52011-4,CDM,320,RC,77075,CPT,,,,,BOTH,,,159.15,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
BONE AGE STUDY,52014-8,CDM,320,RC,77072,CPT,,,,,BOTH,,,104,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FLOURO GUID NDLE PLA,27370-6,CDM,320,RC,77002,CPT,,,,,BOTH,,,216,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FLOURO GUID PICC/CL,99153-9,CDM,320,RC,77001,CPT,,,,,BOTH,,,99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SPINE ULTRASOUND,52205-2,CDM,320,RC,76800,CPT,,,,,BOTH,,,248.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ABD/CHEST CHILD FB,52236-7,CDM,320,RC,76010,CPT,,,,,BOTH,,,47.32,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FLUOROSCOPY FIRST HOUR,52062-7,CDM,320,RC,76000,CPT,,,,,BOTH,,,197,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHUNTOGRAM,5305-8,CDM,320,RC,75809,CPT,,,,,BOTH,,,131.65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
VOIDING CYSTOURETHGM,5255-5,CDM,320,RC,74455,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RETRO URETHROGRAM,52085-8,CDM,320,RC,74450,CPT,,,,,BOTH,,,417,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CYSTOGRAM,52084-1,CDM,320,RC,74430,CPT,,,,,BOTH,,,436,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
BARIUM ENEMA W/AIR,5222-5,CDM,320,RC,74280,CPT,,,,,BOTH,,,401,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
BARIUM ENEMA W/O AIR,5211-8,CDM,320,RC,74270,CPT,,,,,BOTH,,,307,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SMALL BOWEL STUDY,5218-3,CDM,320,RC,74250,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SMALL BOWEL F/THROUG,52225-0,CDM,320,RC,74248,CPT,,,TC,,BOTH,,,104.88,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
AC UGI W/WO ESOPGRAM,5219-1,CDM,320,RC,74246,CPT,,,,,BOTH,,,343,,,73,,225,148.1,250,1 through 10,percent of total billed charges,,,73,,225,148.1,250,1 through 10,percent of total billed charges,,,73,,225,148.1,250,1 through 10,percent of total billed charges,,,73,,225,148.1,250,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
UGI W/WO ESOPHAGRAM,52087-4,CDM,320,RC,74240,CPT,,,,,BOTH,,,545,,,73,,337,165,385,1 through 10,percent of total billed charges,,,73,,337,165,385,1 through 10,percent of total billed charges,,,73,,337,165,385,1 through 10,percent of total billed charges,,,73,,337,165,385,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MOD BARIUM SWALLOW,52065-0,CDM,320,RC,74230,CPT,,,,,BOTH,,,152.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ESOPHOGRAM,5221-7,CDM,320,RC,74220,CPT,,,,,BOTH,,,222,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ACUTE ABD W/CHEST 1V,52001-5,CDM,320,RC,74022,CPT,,,,,BOTH,,,215,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ABD 3V,5212-6,CDM,320,RC,74021,CPT,,,,,BOTH,,,300,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ABD 2V,5210-0,CDM,320,RC,74019,CPT,,,,,BOTH,,,225,,,73,,106.5,1,156.5,1 through 10,percent of total billed charges,,,73,,106.5,1,156.5,1 through 10,percent of total billed charges,,,73,,106.5,1,156.5,1 through 10,percent of total billed charges,,,73,,106.5,1,156.5,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ABD 1V,5209-2,CDM,320,RC,74018,CPT,,,,,BOTH,,,200,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TOES MIN 2 VIEWS,5232-4,CDM,320,RC,73660,CPT,,,,,BOTH,,,152,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
OSCALCIS/HEEL LT,52137-7,CDM,320,RC,73650,CPT,,,LT,,BOTH,,,197,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
OSCALCIS/HEEL RT,5229-0,CDM,320,RC,73650,CPT,,,RT,,BOTH,,,197,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
OSCALCIS/HEEL BI,52138-5,CDM,320,RC,73650,CPT,,,50,,BOTH,,,394,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,73,,115,115,115,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 3 VIEWS LT,52170-8,CDM,320,RC,73630,CPT,,,LT,,BOTH,,,241,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 3 VIEWS RT,5226-6,CDM,320,RC,73630,CPT,,,RT,,BOTH,,,241,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 3 VIEWS BI,52161-7,CDM,320,RC,73630,CPT,,,50,,BOTH,,,486,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,73,,175,140,175,25,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 2 VIEWS LT,52163-3,CDM,320,RC,73620,CPT,,,LT,,BOTH,,,207,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 2 VIEWS RT,52162-5,CDM,320,RC,73620,CPT,,,RT,,BOTH,,,207,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOOT 2 VIEWS BI,52164-1,CDM,320,RC,73620,CPT,,,50,,BOTH,,,414,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 3 VIEWS LT,52176-5,CDM,320,RC,73610,CPT,,,LT,,BOTH,,,238,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 3 VIEWS RT,5224-1,CDM,320,RC,73610,CPT,,,RT,,BOTH,,,238,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 3 VIEWS BI,52177-3,CDM,320,RC,73610,CPT,,,50,,BOTH,,,476,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,73,,173,113,173,11,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 2 VIEWS LT,52179-9,CDM,320,RC,73600,CPT,,,LT,,BOTH,,,215,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 2 VIEWS RT,52178-1,CDM,320,RC,73600,CPT,,,RT,,BOTH,,,215,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ANKLE 2 VIEWS BI,52180-7,CDM,320,RC,73600,CPT,,,50,,BOTH,,,430,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT LOWER EXT BI,52235-9,CDM,320,RC,73592,CPT,,,50,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT LOWER EXT LT,52233-4,CDM,320,RC,73592,CPT,,,LT,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT LOWER EXT RT,52234-2,CDM,320,RC,73592,CPT,,,RT,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TIBIA/FIBULA LT,52127-8,CDM,320,RC,73590,CPT,,,LT,,BOTH,,,237,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TIBIA/FIBULA RT,5231-6,CDM,320,RC,73590,CPT,,,RT,,BOTH,,,237,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TIBIA/FIBULA BI,52128-6,CDM,320,RC,73590,CPT,,,50,,BOTH,,,474,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,73,,164,143.1,173,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 4 VIEWS LT,52144-3,CDM,320,RC,73564,CPT,,,LT,,BOTH,,,307,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 4 VIEWS RT,52108-8,CDM,320,RC,73564,CPT,,,RT,,BOTH,,,307,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 4 VIEWS BI,52145-0,CDM,320,RC,73564,CPT,,,50,,BOTH,,,614,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,73,,448,448,448,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 3 VIEWS LT,52150-0,CDM,320,RC,73562,CPT,,,LT,,BOTH,,,260,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 3 VIEWS RT,5228-2,CDM,320,RC,73562,CPT,,,RT,,BOTH,,,260,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 3 VIEWS BI,52141-9,CDM,320,RC,73562,CPT,,,50,,BOTH,,,520,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,73,,189,168,379,26,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 1 OR 2 VIEWS LT,52142-7,CDM,320,RC,73560,CPT,,,LT,,BOTH,,,239,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 1 OR 2 VIEWS RT,52107-0,CDM,320,RC,73560,CPT,,,RT,,BOTH,,,239,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
KNEE 1 OR 2 VIEWS BI,52143-5,CDM,320,RC,73560,CPT,,,50,,BOTH,,,478,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,73,,224,224,224,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 2 VIEW LT,52168-2,CDM,320,RC,73552,CPT,,,LT,,BOTH,,,240,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 2 VIEW RT,5225-8,CDM,320,RC,73552,CPT,,,RT,,BOTH,,,240,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 2 VIEW BI,52169-0,CDM,320,RC,73552,CPT,,,50,,BOTH,,,480,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 1 VIEW RT,52218-5,CDM,320,RC,73551,CPT,,,RT,,BOTH,,,40.83,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 1 VIEW BI,52216-9,CDM,320,RC,73551,CPT,,,50,,BOTH,,,42.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FEMUR 1 VIEW LT,52219-3,CDM,320,RC,73551,CPT,,,LT,,BOTH,,,42.08,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HIPS 2V W/WO PELVISB,52154-2,CDM,320,RC,73521,CPT,,,,,BOTH,,,330,,,73,,240,181.5,267,1 through 10,percent of total billed charges,,,73,,240,181.5,267,1 through 10,percent of total billed charges,,,73,,240,181.5,267,1 through 10,percent of total billed charges,,,73,,240,181.5,267,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HIP 2V W/WO PELVIS L,52152-6,CDM,320,RC,73502,CPT,,,LT,,BOTH,,,236,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HIP 2V W/WO PELVIS R,5227-4,CDM,320,RC,73502,CPT,,,RT,,BOTH,,,236,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,73,,172,137,197.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HIP 1V W/WO PELVIS L,52146-8,CDM,320,RC,73501,CPT,,,LT,,BOTH,,,270,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HIP 1V W/WO PELVIS R,52155-9,CDM,320,RC,73501,CPT,,,RT,,BOTH,,,270,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FINGER(S) MIN 2 VIEWS,5247-2,CDM,320,RC,73140,CPT,,,,,BOTH,,,152,,,73,,88,88,110,1 through 10,percent of total billed charges,,,73,,88,88,110,1 through 10,percent of total billed charges,,,73,,88,88,110,1 through 10,percent of total billed charges,,,73,,88,88,110,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 3 VIEWS LT,52157-5,CDM,320,RC,73130,CPT,,,LT,,BOTH,,,243,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 3 VIEWS RT,5249-8,CDM,320,RC,73130,CPT,,,RT,,BOTH,,,243,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 3 VIEWS BI,52158-3,CDM,320,RC,73130,CPT,,,50,,BOTH,,,486,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,73,,177,141,283,20,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 2 VIEWS LT,52160-9,CDM,320,RC,73120,CPT,,,LT,,BOTH,,,204,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 2 VIEWS RT,52159-1,CDM,320,RC,73120,CPT,,,RT,,BOTH,,,204,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HAND 2 VIEWS BI,52151-8,CDM,320,RC,73120,CPT,,,50,,BOTH,,,434,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 3 VIEWS LT,52121-1,CDM,320,RC,73110,CPT,,,LT,,BOTH,,,241,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 3 VIEWS RT,5241-5,CDM,320,RC,73110,CPT,,,RT,,BOTH,,,241,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 3 VIEWS BI,52122-9,CDM,320,RC,73110,CPT,,,50,,BOTH,,,481,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,73,,175,99.4,318,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 2 VIEWS LT,52124-5,CDM,320,RC,73100,CPT,,,LT,,BOTH,,,203,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 2 VIEWS RT,52123-7,CDM,320,RC,73100,CPT,,,RT,,BOTH,,,203,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
WRIST 2 VIEWS BI,52125-2,CDM,320,RC,73100,CPT,,,50,,BOTH,,,406,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT UPPER EXT BI,52232-6,CDM,320,RC,73092,CPT,,,50,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT UPPER EXT LT,52230-0,CDM,320,RC,73092,CPT,,,LT,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
INFANT UPPER EXT RT,52231-8,CDM,320,RC,73092,CPT,,,RT,,BOTH,,,399.19,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOREARM 2V LT,52165-8,CDM,320,RC,73090,CPT,,,LT,,BOTH,,,225,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOREARM 2V RT,5248-0,CDM,320,RC,73090,CPT,,,RT,,BOTH,,,225,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FOREARM 2V BI,52156-7,CDM,320,RC,73090,CPT,,,50,,BOTH,,,450,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,73,,178,140.4,215.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 3 VIEWS LT,52173-2,CDM,320,RC,73080,CPT,,,LT,,BOTH,,,238,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 3 VIEWS RT,5246-4,CDM,320,RC,73080,CPT,,,RT,,BOTH,,,238,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 3 VIEWS BI,52174-0,CDM,320,RC,73080,CPT,,,50,,BOTH,,,476,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,73,,140.5,108.6,225.2,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 2 VIEWS LT,52166-6,CDM,320,RC,73070,CPT,,,LT,,BOTH,,,231,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 2 VIEWS RT,52175-7,CDM,320,RC,73070,CPT,,,RT,,BOTH,,,231,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ELBOW 2 VIEWS BI,52167-4,CDM,320,RC,73070,CPT,,,50,,BOTH,,,462,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HUMERUS 2 VIEWS LT,52148-4,CDM,320,RC,73060,CPT,,,LT,,BOTH,,,227,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HUMERUS 2 VIEWS RT,5242-3,CDM,320,RC,73060,CPT,,,RT,,BOTH,,,227,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
HUMERUS 2 VIEWS BI,52149-2,CDM,320,RC,73060,CPT,,,50,,BOTH,,,454,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,73,,165,165,214.6,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
AC JOINT,52028-8,CDM,320,RC,73050,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ARTHROGM SHOULDER2V,52047-8,CDM,320,RC,73040,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDER 2 VIEWS LT,52132-8,CDM,320,RC,73030,CPT,,,LT,,BOTH,,,253,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDER 2 VIEWS RT,5243-1,CDM,320,RC,73030,CPT,,,RT,,BOTH,,,253,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDER 2 VIEWS BI,52133-6,CDM,320,RC,73030,CPT,,,50,,BOTH,,,506,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,73,,184,147,369,17,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDER 1 VIEW LT,52135-1,CDM,320,RC,73020,CPT,,,LT,,BOTH,,,189,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDER 1 VIEW RT,52134-4,CDM,320,RC,73020,CPT,,,RT,,BOTH,,,189,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SHOULDERS 1 VIEW BI,52126-0,CDM,320,RC,73020,CPT,,,50,,BOTH,,,378,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SCAPULA UNI LT,52140-1,CDM,320,RC,73010,CPT,,,LT,,BOTH,,,325,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SCAPULA UNI RT,5244-9,CDM,320,RC,73010,CPT,,,RT,,BOTH,,,325,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SCAPULA BIL,52131-0,CDM,320,RC,73010,CPT,,,50,,BOTH,,,450,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CLAVICLE LT,52171-6,CDM,320,RC,73000,CPT,,,LT,,BOTH,,,211,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CLAVICLE RT,5245-6,CDM,320,RC,73000,CPT,,,RT,,BOTH,,,211,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CLAVICLE BI,52172-4,CDM,320,RC,73000,CPT,,,50,,BOTH,,,422,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,73,,154,154,154,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MYELOGRAM LUMBAR,5286-0,CDM,320,RC,72265,CPT,,,,,BOTH,,,926,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MYELOGRAM THORACIC,5285-2,CDM,320,RC,72255,CPT,,,,,BOTH,,,926,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MYELOGRAM CERVICAL,5284-5,CDM,320,RC,72240,CPT,,,,,BOTH,,,926,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SACRUM & COCCYX,5239-9,CDM,320,RC,72220,CPT,,,,,BOTH,,,175,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SACRO-ILIAC >3 VIEWS,5240-7,CDM,320,RC,72202,CPT,,,,,BOTH,,,175,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,73,,127,127,127,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
PELVIS,5230-8,CDM,320,RC,72170,CPT,,,,,BOTH,,,175,,,73,,3.5,75.3,82.3,1 through 10,percent of total billed charges,,,73,,3.5,75.3,82.3,1 through 10,percent of total billed charges,,,73,,3.5,75.3,82.3,1 through 10,percent of total billed charges,,,73,,3.5,75.3,82.3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
LUMBAR 6V,52060-1,CDM,320,RC,72114,CPT,,,,,BOTH,,,301,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
LUMBAR 4 VIEWS,5238-1,CDM,320,RC,72110,CPT,,,,,BOTH,,,259,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
LUMBAR 2 OR 3 VIEWS,5276-1,CDM,320,RC,72100,CPT,,,,,BOTH,,,217,,,73,,158,121.2,158,28,percent of total billed charges,,,73,,158,121.2,158,28,percent of total billed charges,,,73,,158,121.2,158,28,percent of total billed charges,,,73,,158,121.2,158,28,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ALL SPINE 2-3 VIEW,5250-6,CDM,320,RC,72082,CPT,,,,,BOTH,,,124,,,73,,90,90,90,1 through 10,percent of total billed charges,,,73,,90,90,90,1 through 10,percent of total billed charges,,,73,,90,90,90,1 through 10,percent of total billed charges,,,73,,90,90,90,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SCOLIOSIS SERIES I V,52217-7,CDM,320,RC,72081,CPT,,,,,BOTH,,,55.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
THORACIC 3 VIEWS,5236-5,CDM,320,RC,72072,CPT,,,,,BOTH,,,199,,,73,,116,26.4,145,15,percent of total billed charges,,,73,,116,26.4,145,15,percent of total billed charges,,,73,,116,26.4,145,15,percent of total billed charges,,,73,,116,26.4,145,15,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
THORACIC 2 VIEWS,52188-0,CDM,320,RC,72070,CPT,,,,,BOTH,,,165,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CERVICAL 6V,5235-7,CDM,320,RC,72052,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CERVICAL 4V,7205200-4,CDM,320,RC,72050,CPT,,,,,BOTH,,,222,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,73,,162,162,162,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
C-SPINE 2 OR 3 VIEWS,5234-0,CDM,320,RC,72040,CPT,,,,,BOTH,,,199,,,73,,145,36.8,180.8,18,percent of total billed charges,,,73,,145,36.8,180.8,18,percent of total billed charges,,,73,,145,36.8,180.8,18,percent of total billed charges,,,73,,145,36.8,180.8,18,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
C-SPINE 1 VIEW,52024-7,CDM,320,RC,72020,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
STERNOCLAV JOINT 3V,52029-6,CDM,320,RC,71130,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
STERNUM MIN 2 VIEWS,5208-4,CDM,320,RC,71120,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS BIL W/1V CXR,5203-5,CDM,320,RC,71111,CPT,,,,,BOTH,,,222,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS 2 VIEW BIL,52004-9,CDM,320,RC,71110,CPT,,,,,BOTH,,,266,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS LT W/1V CXR,52139-3,CDM,320,RC,71101,CPT,,,LT,,BOTH,,,260,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS RT W/1V CXR,5202-7,CDM,320,RC,71101,CPT,,,RT,,BOTH,,,260,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,73,,189,189,189,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS 2 VIEW UNI LT,52006-4,CDM,320,RC,71100,CPT,,,,,BOTH,,,133,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RIBS 2 VIEW UNI RT,52005-6,CDM,320,RC,71100,CPT,,,,,BOTH,,,133,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,73,,97,30.8,133,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CHEST 4V OR MORE,5207-6,CDM,320,RC,71048,CPT,,,,,BOTH,,,269,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CHEST 3V,5204-3,CDM,320,RC,71047,CPT,,,,,BOTH,,,164,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CHEST 2V,5206-8,CDM,320,RC,71046,CPT,,,,,BOTH,,,216,,,73,,157,113.5,157,111,percent of total billed charges,,,73,,157,113.5,157,111,percent of total billed charges,,,73,,157,113.5,157,111,percent of total billed charges,,,73,,157,113.5,157,111,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
CHEST 1V,5205-0,CDM,320,RC,71045,CPT,,,,,BOTH,,,175,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,73,,175,175,175,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SOFT TISSUE NECK,52034-6,CDM,320,RC,70360,CPT,,,,,BOTH,,,199,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TMJ'S BI,5265-4,CDM,320,RC,70330,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TMJ'S UNI LT,52130-2,CDM,320,RC,70328,CPT,,,52,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
TMJ'S UNI RT,52129-4,CDM,320,RC,70328,CPT,,,52,,BOTH,,,85,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SKULL MIN 4 VIEWS,5264-7,CDM,320,RC,70260,CPT,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SKULL LESS 4 VIEWS,5278-7,CDM,320,RC,70250,CPT,,,,,BOTH,,,113,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
SINUSES MIN 3 VIEWS,5263-9,CDM,320,RC,70220,CPT,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBITS COMPLETE BI,5266-2,CDM,320,RC,70200,CPT,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBIT UNI LT,52114-6,CDM,320,RC,70190,CPT,,,LT,,BOTH,,,265,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBIT UNI RT,52113-8,CDM,320,RC,70190,CPT,,,RT,,BOTH,,,265,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
NASAL BONES COMPLETE,5261-3,CDM,320,RC,70160,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FACIAL BONES 3 VIEWS,5258-9,CDM,320,RC,70150,CPT,,,,,BOTH,,,199,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,73,,145,145,145,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
FACIAL BONES 1 OR 2V,52186-4,CDM,320,RC,70140,CPT,,,,,BOTH,,,61,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MASTOIDS COMPLETE,5260-5,CDM,320,RC,70130,CPT,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MASTOIDS <3 VIEWS,52043-7,CDM,320,RC,70120,CPT,,,,,BOTH,,,175,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MANDIBLE COMPLETE,5259-7,CDM,320,RC,70110,CPT,,,,,BOTH,,,199,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
MANDIBLE PARTIAL,52187-2,CDM,320,RC,70100,CPT,,,,,BOTH,,,120,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBIT FOREIGN BODYLT,52116-1,CDM,320,RC,70030,CPT,,,LT,,BOTH,,,112.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBIT FOREIGN BODYRT,52115-3,CDM,320,RC,70030,CPT,,,RT,,BOTH,,,112.6,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ORBITS BI FOREIGN BO,52010-6,CDM,320,RC,70030,CPT,,,50,,BOTH,,,225.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
NEPHROSTOMY EXCHANGE,50339-1,CDM,320,RC,50435,CPT,,,,,BOTH,,,1425,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
RENAL CYST ASP,52229-2,CDM,320,RC,50390,CPT,,,TC,,BOTH,,,1595,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ARTHRO SHOULDER INJ,52190-6,CDM,320,RC,23350,CPT,,,26,,BOTH,,,99,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,175,,,,,,,Case Rate,,175,175,
ECHO. M-MODE/2D,99070-5,CDM,480,RC,93306,CPT,,,,,BOTH,,,2094,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,168,,,,,,,Case Rate,,168,168,
EMERG. ROOM-LEVEL 2,20102-0,CDM,450,RC,99282,CPT,,,,,BOTH,,,164,,253,,,,,,,Case Rate,,253,,,,,,,Case Rate,,253,,,,,,,Case Rate,,253,,,,,,,Case Rate,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,150,,,,,,,Case Rate,,150,253,
EMERG. ROOM-LEVEL 1,20101-2,CDM,450,RC,99281,CPT,,,,,BOTH,,,110,,172,,,,,,,Case Rate,,172,,,,,,,Case Rate,,172,,,,,,,Case Rate,,172,,,,,,,Case Rate,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,150,,,,,,,Case Rate,,150,172,
US VENOUS DOP U/L RT,52008-0,CDM,921,RC,93971,CPT,,,RT,,BOTH,,,618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
VENOUS DOPP U/L LT,99073-9,CDM,921,RC,93971,CPT,,,LT,,BOTH,,,618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
VENOUS DOPP U/L BI,99074-7,CDM,921,RC,93970,CPT,,,50,,BOTH,,,1226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
UPP/E ARTERIAL U/S L,52120-3,CDM,921,RC,93931,CPT,,,LT,,BOTH,,,522,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
UPP/E ARTERIAL U/S R,52119-5,CDM,921,RC,93931,CPT,,,RT,,BOTH,,,522,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
UPP/E ARTERIAL U/S B,52112-0,CDM,921,RC,93930,CPT,,,50,,BOTH,,,737,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
LOWER E ARTERIAL LT,52117-9,CDM,921,RC,93926,CPT,,,LT,,BOTH,,,589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
LOWER E ARTERIAL RT,52105-4,CDM,921,RC,93926,CPT,,,RT,,BOTH,,,589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
LOWER E ARTERIAL BI,52118-7,CDM,921,RC,93925,CPT,,,,,BOTH,,,845,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
ABI 3 OR MORE EXT,90304-7,CDM,921,RC,93923,CPT,,,,,BOTH,,,266.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
ANKLE BRACH IND 2 EX,60120-3,CDM,921,RC,93922,CPT,,,,,BOTH,,,163.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
CARTOID ART ULTRASND,99103-4,CDM,921,RC,93880,CPT,,,,,BOTH,,,1214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,,,,,,,Case Rate,,80,80,
MAMMO DIAG TOMO,52228-4,CDM,401,RC,G0279,HCPCS,,,TC,,BOTH,,,55.35,,,73,,55,49.5,55,1 through 10,percent of total billed charges,,,73,,55,49.5,55,1 through 10,percent of total billed charges,,,73,,55,49.5,55,1 through 10,percent of total billed charges,,,73,,55,49.5,55,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,68,
MAMMO DIAG BIL DIG,52206-0,CDM,401,RC,77066,CPT,,,TC,,BOTH,,,273.4,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
MAMMO DIAG U/L DIG,52207-8,CDM,401,RC,77065,CPT,,,LT,,BOTH,,,214.85,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
MAMMO DIAG U/R DIG,52208-6,CDM,401,RC,77065,CPT,,,RT,,BOTH,,,214.85,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
BREAST BPSY U/S PLMT,5253-0,CDM,401,RC,19083,CPT,,,TC,,BOTH,,,1386.93,,,73,,629,1258,1258,1 through 10,percent of total billed charges,,,73,,629,1258,1258,1 through 10,percent of total billed charges,,,73,,629,1258,1258,1 through 10,percent of total billed charges,,,73,,629,1258,1258,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,68,
MAMMO SCREEN BIL DIG,52209-4,CDM,403,RC,77067,CPT,,,TC,,BOTH,,,228.93,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
MAMMO SCREEN U/L DIG,52210-2,CDM,403,RC,77067,CPT,,,LT,,BOTH,,,228.93,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
MAMMO SCREEN U/R DIG,52211-0,CDM,403,RC,77067,CPT,,,RT,,BOTH,,,228.93,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
MAMMO SCR TOMO,52227-6,CDM,403,RC,77063,CPT,,,TC,,BOTH,,,55.35,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,85,,,,,,,Fee Schedule,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,68,,,,,,,Case Rate,,68,85,
FLUTTER DEVICE,60119-5,CDM,410,RC,A9284,HCPCS,,,,,BOTH,,,110.78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PEAK FLOW METER,90308-8,CDM,410,RC,A4614,HCPCS,,,,,BOTH,,,20.03,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
TRACH CHG W/O DILAT,60121-1,CDM,410,RC,99308,CPT,,,,,BOTH,,,121,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
CPT SUBSQ,60007-2,CDM,410,RC,94668,CPT,,,,,BOTH,,,74.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
FLUTTER SUBSEQUENT,90312-0,CDM,410,RC,94668,CPT,,,,,BOTH,,,74.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
CPT DAILY,60081-7,CDM,410,RC,94667,CPT,,,,,BOTH,,,74.28,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
FLUTTER DAILY,90311-2,CDM,410,RC,94667,CPT,,,,,BOTH,,,74.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
"TEAC FLUTTER MDI,NEB",90310-4,CDM,410,RC,94664,CPT,,,,,BOTH,,,74.35,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NEBULIZER TREATMENT,115-6,CDM,410,RC,94640,CPT,,,,,BOTH,,,60,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NEBULIZER TREATMENT,308-7,CDM,410,RC,94640,CPT,,,,,BOTH,,,60,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PULMONARY STRESS TES,60103-9,CDM,410,RC,94618,CPT,,,,,BOTH,,,155.72,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
VITAL CAPACITY,90309-6,CDM,410,RC,94150,CPT,,,,,BOTH,,,129.5,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PFT W/FLOW/VOL LOOP,90313-8,CDM,410,RC,94010,CPT,,,,,BOTH,,,129.3,,,73,,94,80.7,107.3,1 through 10,percent of total billed charges,,,73,,94,80.7,107.3,1 through 10,percent of total billed charges,,,73,,94,80.7,107.3,1 through 10,percent of total billed charges,,,73,,94,80.7,107.3,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MECH VENT SUBSQ,60017-1,CDM,410,RC,94003,CPT,,,,,BOTH,,,537,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MECH VENT INITIAL,60065-0,CDM,410,RC,94002,CPT,,,,,BOTH,,,597,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ABG PUNCTURE,60079-1,CDM,410,RC,36600,CPT,,,,,BOTH,,,47.05,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NASAL TRACH SUC DAIL,60087-4,CDM,410,RC,31720,CPT,,,,,BOTH,,,74.28,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NT SUCTION SUBSEQUEN,90315-3,CDM,410,RC,31720,CPT,,,76,,BOTH,,,74.28,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,73,,853,853,853,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SUBS DIL INC LARYNGY,60123-7,CDM,410,RC,31529,CPT,,,,,BOTH,,,393.12,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
DILATION LRY INT DIL,60122-9,CDM,410,RC,31528,CPT,,,,,BOTH,,,351.2,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SUBSEQ C-PAP/BPAP,60099-9,CDM,412,RC,94660,CPT,,,,,BOTH,,,247.3,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
INITIAL C-PAP/B-PAP,60098-1,CDM,412,RC,94660,CPT,,,,,BOTH,,,297,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MICRO NEB SUBSQ,60012-2,CDM,412,RC,94640,CPT,,,76,,BOTH,,,74.28,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MTRD INH DAILY,60083-3,CDM,412,RC,94640,CPT,,,,,BOTH,,,74.28,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MTRD INHAL SUBSQ,60084-1,CDM,412,RC,94640,CPT,,,76,,BOTH,,,74.28,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SPUTUM IND W/NEB,60011-4,CDM,412,RC,94640,CPT,,,,,BOTH,,,74.28,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NEB TX INITIAL DAILY,60062-7,CDM,412,RC,94640,CPT,,,,,BOTH,,,95,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,73,,69,69,69,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
OXYGEN PER HR,60013-0,CDM,412,RC,,,,,,,BOTH,,,7,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
OXYGEN THERAPY INIT,60064-3,CDM,412,RC,,,,,,,BOTH,,,24,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
E-STIM UNATTENDED,390004-0,CDM,420,RC,G0283,HCPCS,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PROSTHETIC FIT/TRAIN,390876-1,CDM,420,RC,97761,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ORTHO FIT/TRAIN E15M,390855-5,CDM,420,RC,97760,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PROSTHETIC CHECK/E15,390899-3,CDM,420,RC,97703,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
WHEELCHAIR TRAIN E15,390885-2,CDM,420,RC,97542,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SELF CARE/HOME E 15M,390869-6,CDM,420,RC,97535,CPT,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SENSORY TECH E 15M,390900-9,CDM,420,RC,97533,CPT,,,,,BOTH,,,109,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
COGNITIVE SKILL E15M,390887-8,CDM,420,RC,97532,CPT,,,,,BOTH,,,96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
THERAPEUTIC ACT 15M,390034-7,CDM,420,RC,97530,CPT,,,,,BOTH,,,96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
RE-EVALUATION PT,390857-1,CDM,420,RC,97164,CPT,,,,,BOTH,,,138,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION PT HIGH,390039-6,CDM,420,RC,97163,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION PT MOD,390038-8,CDM,420,RC,97162,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION PT LOW,390037-0,CDM,420,RC,97161,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MANUAL THERAPY E15M,390883-7,CDM,420,RC,97140,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
GAIT TRAINING,390002-4,CDM,420,RC,97116,CPT,,,,,BOTH,,,50,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NEUROMUSCULAR RE-ED,390016-4,CDM,420,RC,97112,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
THERAPEUTIC EX 15M,390851-4,CDM,420,RC,97110,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ULTRASOUND E 15M,390010-7,CDM,420,RC,97035,CPT,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ULTRASOUND W/MED,390901-7,CDM,420,RC,97035,CPT,,,GP,,BOTH,,,127,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
IONTOPHERESIS,390854-8,CDM,420,RC,97033,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
E-STIM ATTENDED E15M,390011-5,CDM,420,RC,97032,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PARIFFIN,390012-3,CDM,420,RC,97018,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ICE PACK/HOT PACK,390853-0,CDM,420,RC,97010,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
TENS APPLICATION,390889-4,CDM,420,RC,64550,CPT,,,,,BOTH,,,152,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
E-STIM UNATTENDED,3900013-8,CDM,430,RC,G0283,HCPCS,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PROSTHETIC FIT/TRAIN,3900019-5,CDM,430,RC,97761,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ORTHO FIT/TRAIN E15M,3908550-1,CDM,430,RC,97760,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PROSTHETIC CHECK/E15,3900041-9,CDM,430,RC,97703,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
WHEELCHAIR TRAIN E15,3900022-9,CDM,430,RC,97542,CPT,,,,,BOTH,,,77,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SELF CARE/HOME E15M,3908690-5,CDM,430,RC,97535,CPT,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SENSORY TECH E 15M,3900042-7,CDM,430,RC,97533,CPT,,,,,BOTH,,,109,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
COGNITIVE SKILL E15M,3900011-2,CDM,430,RC,97532,CPT,,,,,BOTH,,,96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
THERAPEUTIC ACT 15M,3900340-5,CDM,430,RC,97530,CPT,,,,,BOTH,,,96,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
RE-EVALUATION OT,390882-9,CDM,430,RC,97168,CPT,,,,,BOTH,,,143,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION OT HIGH,3900025-2,CDM,430,RC,97167,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION OT MOD,3900024-5,CDM,430,RC,97166,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION OT LOW,3900023-7,CDM,430,RC,97165,CPT,,,,,BOTH,,,218,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MANUAL THERAPY E15M,3900016-1,CDM,430,RC,97140,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
NEUROMUSCULAR RE-ED,3900160-7,CDM,430,RC,97112,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
THERAPEUTIC EX 15M,3908510-5,CDM,430,RC,97110,CPT,,,,,BOTH,,,58,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ULTRASOUND E 15M,3900021-1,CDM,430,RC,97035,CPT,,,,,BOTH,,,101,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ULTRASOUND W/MED,3900043-5,CDM,430,RC,97035,CPT,,,GP,,BOTH,,,127,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
IONTOPHERESIS,3900015-3,CDM,430,RC,97033,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
E-STIM ATTENDED E15M,3900012-0,CDM,430,RC,97032,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PARAFFIN,3900018-7,CDM,430,RC,97018,CPT,,,,,BOTH,,,36,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ICE PACK/HOT PACK,3900014-6,CDM,430,RC,97010,CPT,,,,,BOTH,,,78,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
TENS APPLICATION,3900020-3,CDM,430,RC,64550,CPT,,,,,BOTH,,,152,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
COGNITIVE SKILL E15M,390894-4,CDM,444,RC,97532,CPT,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
ASSESSMET OF APHASIA,390875-3,CDM,444,RC,96105,CPT,,,,,BOTH,,,257,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
MOD BARIUM SWALLOW,390863-9,CDM,444,RC,92610,CPT,,,,,BOTH,,,168,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SWALLOWING TREATMENT,390866-2,CDM,444,RC,92526,CPT,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SPEECH THERAPY TX,390864-7,CDM,444,RC,92507,CPT,,,,,BOTH,,,106,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EVALUATION SPEECH,390859-7,CDM,444,RC,92506,CPT,,,,,BOTH,,,210,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
RE-EVALUATION SPEECH,390874-6,CDM,444,RC,92506,CPT,,,,,BOTH,,,210,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PULSE OX OVERNIGHT,602076-2,CDM,460,RC,94762,CPT,,,,,BOTH,,,163.48,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PULSE OX DURING EXERCISE,60105-4,CDM,460,RC,94761,CPT,,,,,BOTH,,,65,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PULSE OX INTERM,602075-4,CDM,460,RC,94760,CPT,,,,,BOTH,,,43,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PFT INCOMPLETE,90316-1,CDM,460,RC,94060,CPT,,,73,,BOTH,,,247,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
PFT W/FVL PRE/POST,90314-6,CDM,460,RC,94060,CPT,,,,,BOTH,,,247,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,73,,180,180,180,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EKG,90300-5,CDM,730,RC,93005,CPT,,,,,BOTH,,,125,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
EKG REPEAT,99547-2,CDM,730,RC,93005,CPT,,,76,,BOTH,,,125,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,73,,91,55.8,148.41,61,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,63,,,,,,,Case Rate,,63,63,
SEQUENTIAL IV PUSH,963750-5,CDM,260,RC,96375,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-PUSH SINGLE/INITI,963740-6,CDM,260,RC,96374,CPT,,,,,BOTH,,,39.13,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,73,,39,39,39,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-SQ OR IM,963720-8,CDM,260,RC,96372,CPT,,,,,BOTH,,,39.13,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,73,,1,1,1,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-EACH ADD HOUR,963664-8,CDM,260,RC,96370,CPT,,,,,BOTH,,,39.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
SUBQ INFUSION TO 1HR,963663-0,CDM,260,RC,96369,CPT,,,,,BOTH,,,146.29,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-SEQ INF TO 1 HOUR,963661-4,CDM,260,RC,96367,CPT,,,,,BOTH,,,39.13,,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,73,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-EACH ADD HOUR,963660-6,CDM,260,RC,96366,CPT,,,,,BOTH,,,27.01,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,73,,81,81,81,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-INITIAL TO 1 HOUR,963650-7,CDM,260,RC,96365,CPT,,,,,BOTH,,,146.24,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,73,,146,146,146,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-EACH ADD HOUR,963610-1,CDM,260,RC,96361,CPT,,,,,BOTH,,,27.01,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,73,,27,27,27,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,
IV-INITIAL 31MIN-1HR,963600-2,CDM,260,RC,96360,CPT,,,,,BOTH,,,74.69,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,73,,74,74,74,1 through 10,percent of total billed charges,,,15,,,,,0,percent of total billed charges,No claims adjudicated in the past 12 months.,45,,,,,,,Case Rate,,45,45,